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 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 about 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 per cent reduction in desflurane use since January and has slashed its anaesthesia bill by £73,000.

Dr Geraldine Gallagher, consultant anaesthetist at Glasgow Royal Infirmary and adviser 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.

Ms Gallagher added: “What we have tried to do is make sure all our anaesthetic colleagues make an informed choice when they are 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.

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It has been estimated one bottle of desflurane emits the same amount of CO2 – one tonne – as a daily eight-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 (carbon dioxide equivalent) 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 fewer cars commuting to the hospital every day. We have done this while maintaining high standards of anaesthetic care to our patients.

“It has been estimated 5% of carbon dioxide equivalent emissions from 
acute hospitals are due to the use of inhalational agents. This is equivalent to about 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.

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