Why hospitals are looking at anesthesia to curb emissions

With hospitals facing more pressure to reduce their harm to the environment, some health systems are looking at one big contributor of greenhouse gases.

Specifically, some hospitals are looking at the anesthesia they are using. Hospitals and health systems are switching the anesthesia they are using to reduce their carbon footprint.

Some hospitals are moving away from the use of desflurane, a common anesthetic which is highly damaging to the environment. Desflurane has the “highest global warming potential” of all inhaled anesthetics, and it lasts in the atmosphere for 14 years, according to the American Society of Anesthesiologists.

Providence has been moving away from the use of desflurane. Beth Schenk, Providence’s chief environmental stewardship officer, says desflurane “is a particularly strong greenhouse gas,” about 2,400 times more potent than carbon dioxide.

In recent years, Providence has curbed its use of desflurane, which is better for the environment and better for the system’s bottom line. Providence and other hospitals have moved to using sevoflurane instead of desflurane, which is far less harmful.

• Read more: How Providence is making its hospitals more sustainable

In addition to being bad for the environment, desflurane also has another disadvantage.

“It turns out, it's expensive,” Schenk says. “So that's a great way that environmental stewardship aligns with cost savings, and we look for those because those are the easiest ones to do.

“So, in reducing the use of that particular drug, we have been able to drive down our emissions significantly from anesthetic gases and save several million dollars every year,” she explains. “We're still working on that. We're not all the way through, but making good progress.”

Hospitals and health systems are facing growing pressure to reduce their emissions, waste and pollutants. The healthcare industry is responsible for 8.5% of America’s carbon emissions, federal officials say. More hospital leaders acknowledge that they need to do better to create healthier communities.

• Read more: Joint Commission CEO talks about new sustainability program for hospitals

Anesthesia accounts for a significant portion of hospital emissions. Providence has estimated that as much as 40% of the system’s “scope 1” greenhouse gases come from anesthetics. The Environmental Protection Agency defines “scope 1” emissions as greenhouse emissions that are owned or controlled by an organization.

Other health systems have moved away from using desflurane. UC Davis says it stopped using desflurane years ago, and also uses sevoflurane.

Nina Schloemerkemper, a professor and clinical director of Obstetric Anesthesia at UC Davis Health, said in a news release last year that using desflurane for one hour “is equivalent to driving a car for 400 miles.” Conversely, using sevoflurane is comparable to driving a car for six miles, she said.

• Read more: How hospitals can improve their sustainability, and why they should get moving

In March 2023, Scotland virtually eliminated the use of desflurane in the nation’s hospitals, leaving exceptions for extreme clinical circumstances. NHS Scotland said phasing out the use of desflurane over the course of one year would be the equivalent of driving between Glasgow and London 42,500 times. NHS Scotland has also set a goal of being net-zero for anesthetic gases by 2027.

UCSF Health has moved away from using desflurane in recent years. Seattle Children’s has stopped using desflurane, and has set a goal of reducing the organization’s emissions 50% by 2030. UPMC said last fall that it was phasing out the use of desflurane over the next several months.

A busy mid-sized hospital purchases about 1,000 liters of inhaled anesthetics annually, so depending on which anesthetic are used, each mid-sized hospital's use of anesthetics would be equivalent to 100 to 1,200 car emissions each year, according to a 2012 article in Anesthesia Progress.

Health systems also are taking a look at the use of nitrous oxide, often called laughing gas, to reduce emissions. Nitrous oxide lasts in the atmosphere for 114 years, according to the American Society of Anesthesiologists.

Providence has cut the use of nitrous oxide, Schenk says. She credited Brian Chesebro, MD, an anesthesiologist and medical director of environmental stewardship for Providence, for tracking down the waste in nitrous oxide.

Chesebro discovered that most of the nitrous oxide Providence used was leaking through pipes in the walls, Schenk said. The leaking nitrous oxide wasn’t harming staff or patients, but was escaping into the atmosphere. Providence uncovered the leaks when it found that clinicians were using far less nitrous oxide than the system was purchasing.

So Providence switched from using the in-wall pipe systems to using cylinders of nitrous oxide attached to anesthesia carts. It’s another instance of reducing emissions and saving money, Schenk said. Providence said it drastically reduced the loss of nitrous oxide, cutting gas loss in 99% in some cases.

“No one has to give up using nitrous but we're not going to tolerate that much waste,” Schenk said.

Researchers have called for hospitals to move away from administering nitrous oxide through piping. Between 70% and 90% of nitrous oxide is lost through facility piping, researchers noted in a February 2023 article published by the Joint Commission Journal on Quality and Patient Safety.

The American Society of Anesthesiologists has advised hospitals to reduce the use of both desflurane and nitrous oxide.

More hospitals are shutting down pipe-delivery systems of nitrous oxide, says Kara Brooks, senior associate director of sustainability for the American Society for Health Care Engineering.

“We've had a number of health systems actually do the research and do the analysis and found that they're leaking a large amount of their nitrous oxide,” Brooks says. “And because of that, they're starting to decommission those systems.”

This month, Chief Healthcare Executive® is presenting stories on sustainability in hospitals, leading up to Earth Day. Feel free to share ideas or success stories. Email: [email protected].