Evaluation of a protocol to reduce the environmental impact of anaesthetic gases

Editor—Ecosystem changes as a result of climate change have clear detrimental effects on human health. The healthcare sector globally contributes about 5.2% of total greenhouse gas emissions, ranking as the fifth largest emitter if considered a country. 1 Romanello M. Di Napoli C. Drummond P. et al. The 2022 report of the Lancet Countdown on health and climate change: health at the mercy of fossil fuels. Lancet. 2022; 400: 1619-1654 Google Scholar In high-income countries, greenhouse gas emissions from a single surgery averaged approximately 184 kg CO2 equivalent (CO2e) in 2017, and emissions as a result of inhaled anaesthetic gases surpassed those from surgical equipment, waste, and energy consumption combined, including heating, ventilation, and air conditioning. 2 MacNeill A.J. Lillywhite R. Brown C.J. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health. 2017; 1: e381-e388 Google Scholar Inhaled anaesthetic gases are potent greenhouse gases, and their impact is assessed using the Global Warming Potential index over 100 yr (GWP100). Desflurane has a GWP100 of 2540 (1 g of desflurane has the same GWP as 2540 g of CO2), whereas sevoflurane has a GWP100 of 130 and nitrous oxide (N2O) has a GWP100 of 265. 3 Sulbaek Andersen M.P. Sander S.P. Nielsen O.J. Wagner D.S. Sanford T.J. Wallington T.J. Inhalation anaesthetics and climate change. Br J Anaesth. 2010; 105: 760-766 Google Scholar Because of environmental concerns and uncertainties regarding its clinical benefits, Scotland became the first national health system to ban desflurane. Efforts to reduce the greenhouse gas emissions of the operating theatre by changing inhaled anaesthetic gases and terms of use seem to be a quick and relatively simple win, compared with more challenging efforts to reduce the environmental impact of engineering and equipment purchasing for operating theatres (e.g. replacing single use with reusable equipment).