Physician anesthesiologists find opportunity to reduce carbon footprint

Often overlooked in estimates of the carbon footprint created by the health care industry, inhaled anesthetics contribute significantly to greenhouse gas emissions, suggests research being presented at the ANESTHESIOLOGY™ 2014 annual meeting. Switching to different types of anesthesia can reduce anesthesia-related emissions by more than 11 times, the study found.

A previous study estimated that the U.S. health care sector’s carbon footprint accounts for 8 percent of the country’s total greenhouse gases, but didn’t include inhaled anesthesia. The new research estimates inhaled anesthesia accounts for approximately 1 percent of the U.S. health sector’s greenhouse gases. To calculate that percentage, researchers applied inhaled anesthetic data gathered from three hospitals in the United States, and used case number estimates from the Anesthesia Quality Institute’s National Anesthesia Clinical Outcomes Registry (NACOR) on more than 13 million anesthetics. Other health system contributors to greenhouse gas emissions include building energy use, and the manufacture, shipping and waste management of health-related products including medications and devices.

“Everyone in health care should strive to reduce the industry’s pollution footprint,” said Jodi Sherman, M.D., lead author of the study and assistant professor of anesthesiology and environmental compliance officer, Yale University, School of Medicine, New Haven, Conn. “Health care pollution is a patient safety issue, with indirect costs to society that are as yet unaccounted for. The good news is we can easily reduce this pollution at no added cost.”

The first solution researchers suggest is to avoid using the anesthesia gases with the biggest carbon dioxide (CO2) emissions, desflurane and nitrous oxide. They suggest substituting sevoflurane and isoflurane, which are 20 times less polluting but still effective, or propofol when possible as it is four orders of magnitude less polluting. When Yale-New Haven Hospital stopped using those two gases alone, inhaled anesthetic gas emissions were reduced 11-fold, Dr. Sherman said. Other solutions include: reducing the gas flow rates of inhaled anesthesia, which can be done safely while maintaining effective anesthesia; recapturing waste anesthetic gases after use; and using intravenous and regional anesthetic techniques rather than inhaled anesthesia when appropriate.

“This is a new concept, and inhaled anesthetics are a really low-hanging fruit to target for a significant reduction in greenhouse gas pollution,” said Dr. Sherman.