Inhalation anesthesia - Big contributor to environmental contamination

The healthcare business is a significant polluter, accounting for about 5 percent of global greenhouse gas emissions. All health practitioners have a responsibility to avoid environmental pollution due to their fundamental objective of promoting health and healing. Inhaled anesthetics are a source of greenhouse gases that is specific to clinical settings, making them of special importance.

Anaesthesiology has produced a substantial body of work analyzing the emissions of these gases and creating mitigation strategies that do not compromise patient care or safety. Recent publications attempted to address the problem.

All inhaled anesthetics are powerful greenhouse gases with heat-trapping qualities (potential for global warming) hundreds to thousands of times larger than carbon dioxide.

Additionally, several inhaled anesthetics, including nitrous oxide (N2O), contribute to the depletion of the ozone layer. During clinical usage, the majority of inhaled anesthetics are exhaled via gas scavenging (vacuum) devices to prevent against occupational exposure and are eventually all discharged into the external environment uncontrolled.

Approaches to cut down on inhaled anesthetic pollution (adapted from Devlin-Hegedus et al)

Clinical practice

When it is clinically safe to do so, avoid inhaled anesthetics and substitute intravenous, regional, or neuraxial anesthesia.

Avoid desflurane and N2O if you are administering inhaled anesthetics.

Reduce rates of fresh gas supply, especially during inductions.

Buildings

Decommission existing N2O central pipe systems and refrain from constructing new ones, and replace them with portable tanks that are sealed between usage.

Consider technology for treating and reusing anesthesia gases only after all other measures for waste avoidance have been perfected.

Industry regulations and standards

Avoid N2O as a cryosurgery refrigerant.

Implement national reporting and reduction of inhaled anesthetic greenhouse gas and ozone depleting emissions in accordance with the Montreal protocol, including the Kigali amendment on hydrofluorocarbons8, and the Paris Agreement.

A regulatory framework requiring standardized, obligatory reporting and accountability is essential for achieving the broad participation necessary to minimize the considerable greenhouse gas emissions of the healthcare industry.

References –

Sherman J D, Chesebro B B. Inhaled anaesthesia and analgesia contribute to climate change BMJ 2022; 377 :o1301 doi:10.1136/bmj.o1301

Devlin-Hegedus JH, McGain F, Sherman JD. Action guidance for addressing inhaled anaesthetic pollution. Anaesthesia