SUSTAINABILITY SNAPSHOT SERIES:

ENVIRONMENTALLY SUSTAINABLE OPPORTUNITIES FOR HEALTH SYSTEMS

Anesthetic gases are essential to providing comfortable and safe surgery. Yet these agents are also recognized greenhouse gases (GHGs) and contribute to the environmental impact of healthcare (1). A 2012 report from the English National Health Service in the United Kingdom found that these anesthetic gases comprised 5% of the carbon footprint from acute care institutions (2). At a global scale, these gases have been found to be increasingly accumulating in the atmosphere, and estimates from 2014 found anesthetic gas release globally was equivalent to 3.1 million tons of carbon dioxide (3).

How do anesthetic gases contribute to climate change? Halogenated anesthetic gases are liquid agents added to the anesthetic breathing circuit in a carrier gas mixture (which may include nitrous oxide) that the patient inhales. The majority of anesthetic gases used during surgery are ultimately exhaled, as they undergo minimal metabolism during respiration (4). These exhaled excess gases are channeled out of the patient breathing circuit and collected by “scavenging” systems in anesthesia machines. These scavenging systems reduce operating room personnel exposure to anesthetic gases. Waste gases from scavenging are often vented as medical waste gas directly into the surrounding area (5). Waste anesthetic gases remain in the lower atmosphere for years. It is estimated that sevoflurane remains in the atmosphere for 1.4 years, desflurane for 21.4 years and nitrous oxide for up to 150 years (1,6,7). Once in the atmosphere, these gases contribute to the greenhouse effect and in turn global climate change (8).

The release of anesthetic gases represents a major challenge to environmental sustainability in healthcare. To address this issue, clinicians and administrators can pursue some of all of the following options to mitigate the environmental impact of anesthetic gases:

1. Measurement of gas use for benchmarking and program monitoring and evaluation

2. Choosing anesthetic gases with lower environmental impacts

3. Choosing an appropriate carrier gas

4. Managing anesthetic technique

5. Use of appropriate anesthetic scavenging and recycling technology

6. Resource Stewardship

These options can be part of a comprehensive strategy to improve the environmental performance of the operating room.

View the full Anesthetic Gases Sustainability Snapshot to learn more about these sustainability interventions, and download the infographic below for a quick reference..

If you have thoughts or examples you’d like to share related to this Sustainability Snapshot, please add them in the comments section below.