Greenhouse gas reduction in anaesthesia practice: a departmental environmental strategy

Abstract

Sustainability interventions were implemented at the Royal Brisbane and Women’s Hospital (RBWH) following identification of inhaled anaesthetic gases as a target for reducing medical carbon emissions. This quality improvement study assessed and evaluated the impact of sustainability interventions on the environmental and financial cost of inhaled anaesthetic gas use in order to guide future initiatives and research in reducing carbon emissions from healthcare practice.Ethical exemption was granted from the RBWH Research Ethics Committee (EX/2021/QRBW/76078). Usage (bottles) and expenditure for desflurane and sevoflurane from January 2016 to December 2021 were obtained. Global warming potential and carbon dioxide equivalent (CO2e) were used to report environmental impact of volatile agents. Methods to estimate this were performed in Excel based on Campbell and Pierce methodology. An Environmental Protection Agency greenhouse gas equivalency calculator was used to convert CO2e to equivalent petrol carbon emissions and kilometres travelled by a typical passenger vehicle.The total number of bottles of sevoflurane and desflurane purchased between January 2016 and December 2021 decreased by 34.76% from 1991 to 1299. The number of desflurane bottles purchased decreased by 95.63% from 800 to 35 bottles. The number of sevoflurane bottles purchased increased by 6.13% from 1191 bottles to 1264 bottles. This was achieved by implementing quality improvement interventions such as staff education of desflurane-sparing practices, distribution of posters and progressive removal of desflurane from operating theatres. Total carbon emission from volatile anaesthetics equalled 2326 tonnes CO2e. Combined desflurane and sevoflurane emissions decreased by 87.88%. In 2016, desflurane made up 92.39% of the annual CO2e, which steadily decreased to 33.36% in 2021. Combined sevoflurane and desflurane usage costs decreased by 58.33%.Substantial reductions in carbon emissions from volatile anaesthetics demonstrate the significant degree to which environmentally sustainable practices have been implemented. Applying desflurane-sparing practice can heavily limit anaesthetic drug expenditure and contribution to environmental waste. This is important given the global health sector’s challenge to optimise patient outcomes in the face of global climate change crisis.

Green nudges for sustainable anaesthetic practice: institutional support to make individual change easier

“…Labelling interventions are not merely information provision; they alter the factors considered at the moment of decision‐making, helping to frame salient information and highlight factors that do not readily come to mind [16]. Labelling vaporisers is a simple and cheap intervention that has been used at some centres to reduce the use of volatile anaesthetics, particularly desflurane [26, 27]. A well‐designed anaesthetic label could reframe the decision as an environmental choice, not just one of convenience and familiarity.…”

“…Labelling vaporisers is a simple and cheap intervention that has been used at some centres to reduce the use of volatile anaesthetics, particularly desflurane [26,27]. A welldesigned anaesthetic label could reframe the decision as an environmental choice, not just one of convenience and familiarity.…”

High-Impact Actions to Reduce the Carbon Dioxide Footprint in an Ophthalmic Operation Room: A Narrative Review

“…Modern VAs include the hydrofluorocarbons sevoflurane and desflurane and the chlorofluorocarbon isoflurane. These undergo minimal in vivo metabolism and are released virtually unchanged (≥95%) into the troposphere, which is the lowest layer of the atmosphere in which the greenhouse gas (GHG) effect occurs [16]. Desflurane is known to remain in the troposphere for 14 years, while in contrast, sevoflurane remains in the troposphere for only 1.4 years [17].…”

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

“…Several studies have explored the potential reduction of the carbon footprint of anaesthesia through educational campaigns that encourage the transition from desflurane to sevoflurane, and the removal of nitrous oxide [9,10].…”