Anaesthetic gases account for approximately 5% of hospital greenhouse gas emissions. Desflurane and Nitrous Oxide (N2O) have the highest emissions. The global warming potential of desflurane is 6,810 times that of CO2, with an atmospheric lifetime of 14 years.
Desflurane is also an expensive anaesthetic agent, with many international and Australian health systems now phasing out desflurane. NSW Health has reduced its use in recent years as anaesthetists shift to clinically equivalent and lower emissions alternatives. In March 2024, the NSW Health Formulary Committee removed desflurane from the NSW Medicines Formulary, citing the availability of alternatives and concerns about the financial and environmental impacts of desflurane. Anaesthetists are still able to use desflurane via the IPU (individual patient usage) process. The desflurane project at Bankstown-Lidcombe Hospital aimed to investigate, measure, and reduce departmental use of volatile anaesthetics (desflurane and sevoflurane) by introducing an educational, behavioural, motivational and systems change intervention.
Reducing consumption through education
The multi-component intervention was the first of its kind within South Western Sydney Local Health District (SWSLHD). The project was conducted in the anaesthetic department of Bankstown-Lidcombe Hospital 2022-2024. The project aimed to reduce desflurane consumption by educating and encouraging staff to consider the environmental impact of volatile anaesthetics. The project involved:
- formal group education delivered by an anaesthetist to anaesthetic consultants, trainees, and nursing staff
- trainee-specific training program and grand round presentations
- information sharing via an anaesthesia WhatsApp group and education poster and bulletin article
- clinician survey (n=36)
- establishment of a theatre sustainability committee
- presentations and reporting to the anaesthetic department and district sustainability committee.
The education intervention aimed to improve staff understanding of the principles of sustainable healthcare, the environmental impact of volatile agents, avoiding use of desflurane, alternatives to desflurane and volatile gases and promoting low flow anaesthesia and propofol-based total intravenous anaesthesia (TIVA). Outcome measures included the usage, costs, and environmental impact (emissions) of volatile anaesthetic agents and indicators of TIVA trends.
Project achieves saving of 239,100kg C02e
The project was successful in reducing desflurane consumption and significantly reducing costs. It also demonstrated an increase in use of TIVA with propofol, with increased use per patient episode compared to volatile anaesthesia. Desflurane usage reduced resulting in an approximate annual cost saving of $24,120 in one anaesthetic department. The project achieved an approximate annual carbon saving of 239,110kg CO2e.The approach is well-suited for use in anaesthetic department settings. It can be easily implemented using current resources and generates a reduction in healthcare costs
