Abstract
Background: The fifth largest contributors of greenhouse gases (GHGs) worldwide are healthcare systems.1 In 2015, the National Health Service (NHS) contributed ∼4.6% of national GHGs.2 The NHS sustainable team has labelled anaesthetic volatile gases (GHG) as a ‘carbon hotspot’.3 The NHS Long Term Plan is to reduce 40% of emissions from anaesthetic agents.4 The global warming potential (GWP100) of desflurane is almost 20 times more than that of sevoflurane.5 A rapid transition in anaesthetic practice is vital. Desflurane should be discontinued and lower flow rates of sevoflurane must be used as the lower the flow rates, the lower the carbon dioxide (CO2) equivalence of the gas.1 Methods: The aim of this report is to evaluate volatile gas use from anaesthetic machines at the Royal Bolton Hospital (RBH) over an average 4-week period. Raw data from Drager Perseus A500 Anaesthetic machines were collected across 13 operating theatres. A questionnaire regarding volatile anaesthetic gas use was created and disseminated to the RBH anaesthetic department. Results: Some 86.9% of cases used volatile gases (84.2% used sevoflurane, 2.2% used desflurane). The duration of surgery and fresh gas flow affect efficiency of uptake of gas. There are barriers to using total i.v. anaesthesia including lack of availability of equipment and training. Figure 2 shows the efficiency of uptake of sevoflurane vs lowest fresh gas flow. Conclusion: The department has shown an encouraging reduction in desflurane usage. After choice of anaesthetic agent, the use of low flow rates is essential for sustainable practice, as the lowest possible flows allow for lowest CO2 emissions. There can be further sustainable improvements with reduction in sevoflurane and increase in non-volatile anaesthetic delivery. 1Van Norman GA, Jackson S. Curr Opin Anaesthesiol 2020; 33: 577–832United Kingdom National Statistics. 2015 UK Greenhouse Gas Emissions, Final Figures. Department for Business, Energy and Industrial Strategy. [Internet] 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604350/2015_Final_Emissions_statistics.pdf (accessed 20/03/23)3Shelton CL, Sutton R, White SM. Br J Anaesth 2020; 125: 852–64NHS England. Delivering a ‘Net Zero’NHS. London: NHS England. [Internet] 2020: 5–33 https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf (accessed 20/03/23)5Anderson MPS, Nielsen OJ, Wallington TJ, Karpichev B, Sander SP. Anesth Analg 2012; 114: 1081–5
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