Scotland’s largest health board has changed the type of anaesthetic gas it uses in an effort to reduce its carbon footprint.

NHS Greater Glasgow and Clyde (NHSGCC) uses a significant amount of the gases used to put patients to sleep for surgery but is expected to save up to £100,000 per year by introducing a lower carbon alternative.

Sevoflurane is 60 times less polluting than desflurane, the hydrocarbon gas that was used as standard until recently.

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After use, anaesthetic gases are released into the atmosphere with desflurane having a global warming potential that is 20 times higher than sevoflurane.

The gases represent an estimated five per cent of the carbon footprint for all acute NHS organisations.

Desflurane stays in the atmosphere for around 14 years - almost 13 more than its alternative, which lasts for just over a year.

Aside from the price and environmental cost, there is little difference between the two, although desflurane may still be required in some instances.

NHSGCC anaesthetists concerned about the environmental impact of desflurane launched a Quality Improvement Project to promote sevoflurane as a safe alternative for most patients. 

NHS Highland has seen a 75% reduction in desflurane use since January and have slashed their anaesthesia bill by £73,000.

Dr Geraldine Gallagher, consultant anaesthetist at Glasgow Royal Infirmary and advisor to the project, said: “Clinically there is not a lot to choose from between the two anaesthetic gases. Because desflurane  has a much more profoundly  deleterious effect on the environment, in most situations it makes sense to choose sevoflurane.”

In surgeries that require a long anaesthetic, desflurane is the better choice because it is released from a patient’s body more quickly than the lower carbon alternative - allowing them to wake up more quickly.

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Dr Gallagher added: “What we’ve tried to is make sure all our anaesthetic colleagues make an informed choice when they’re deciding which one to use and if they do use desflurane it is because of sound clinical reasons and not just because it’s there.”

Other options to put patients to sleep include intravenous anaesthetics, which have even less impact on the environment.

It has been estimated that one bottle of desflurane emits the same amount of co2 - one tonne- as a daily 8 mile round trip made by car for 46 weeks of the year.

A recent study, published in The Lancet Planetary Health journal, highlights the potential for reducing emissions in health care settings and, at the same time, potentially reducing costs. Emissions due to anaesthetic gases accounted for approximately 2,000 tonnes of CO2e at two North American sites – ten-fold higher than the anaesthetic gas emissions from the UK hospital. The authors say this is largely the result of a higher usage of desflurane in the two North American hospitals.

Dr Stephen Young, consultant anaesthetist, said “This is a really significant environmental change, with a carbon dioxide equivalent reduction of 350 less cars commuting to the hospital every day. We have done this whilst maintaining high standards of anaesthetic care to our patients.

“It has been estimated that five per cent of carbon dioxide equivalent (CO2e) emissions from acute hospitals are due to the use of inhalational agents. This is equivalent to around half the CO2 used to heat all hospital buildings and water.

“This is just one of the areas in which NHSGGC is driving forward a focus on sustainability and making a difference to its carbon footprint.”

Dr Cathy Lawson is the National Fellow for Sustainable Anaesthesia for the Association of Anaesthetists and the Centre for Sustainable Health Care in collaboration with the Newcastle Upon Tyne hospitals.

In her role, Dr Lawson works towards implementing sustainable systems within anaesthesia, encouraging doctors and hospitals to consider their environmental footprint by considering alternatives to established practices.

One of the initiatives devised by the fellowship is to build the Environmental Champions Network comprised of one anaesthetist volunteer from every hospital in the UK and Ireland so that information can be shared.

Dr Lawson said: “We know that people are starting to embed sustainability and sustainable projects within anaesthesia and there’s been some really great work done and some really good ideas.

“What we hope the network will achieve is to help promote the work that people have done locally on a national scale so that people can see what projects have happened around the country and think they could do them too.”

Eventually, the network will be used to collect national data sets and get more information from hospitals so the fellowship can work on more concrete data and less estimates.

Dr Lawson said: “If we have more accurate data we can get more accurate values of carbon foot-printing from some of our areas of practice that we know are high carbon impact.”

She echoes Dr Gallagher by saying that patient safety must always come first, and that will sometimes mean using less the sustainable desflurane gas.
There are other initiatives being investigated that can lower emissions including recycling schemes and waste distribution.  

Dr Lawson said: “Anaesthetics and theatres are a really resource intensive area of a hospital with lots of staff, lots of  equipment, we use a lot of medication and we use a lot of water, energy and light.

“As an industry, we’re really trying to step up in terms of sustainability and looking at the products that are coming into the supply chain and in hospitals in the first place. Making sure they are sustainable, reusable, where possible, and not going to compromise any patient safety.”