Background: Anaesthetic gases are responsible for 3% of the NHS carbon footprint. The NHS Long Term Plan aims to reduce this by 40% by: shifting away from desflurane use; effective capture, destruction, or reuse of volatiles and reduction in atmospheric release from leftover nitrous oxide gas canisters.1 A 240 ml bottle of desflurane costs £63, producing 886 kg of carbon dioxide emissions (CO2e) compared with a 250 ml bottle of sevoflurane which costs £44.99 producing 49 kg.2 We aim to reduce our carbon footprint by reducing desflurane use, encouraging low flow anaesthesia and use of TIVA. Methods: A departmental questionnaire was sent to assess knowledge of the environmental impact anaesthetic gases cause and gauge desflurane use. The pharmacy provided procurement data for sevoflurane, desflurane, and 2% propofol for 2019. Our intervention was to remove desflurane from all anaesthetic machines after consultation. TIVA training for trainees was provided and 6-month pharmacy procurement data obtained. Results: The majority (89%) use low flow anaesthesia with volatiles and interest in TIVA use is increasing. The inaccessibility of desflurane has led to a 100% decrease in use this 6-month period. Over a year, this could lead to savings of £26 124.68 and 455 240 kg CO2e (Table 5).Table 5Comparison of cost and CO2e usage before and after removal of desflurane.AnaestheticBottles usedTotal cost (£)Total CO2e (kg)2019August 21–January 222019Projected 20222019Projected 2022Sevoflurane40227518 085.9824 744.5019 69826 950Desflurane522032 8660462 4920Propofol 2%119061821422224.8000Total53 093.9826 969.30482 19026 950 Open table in a new tab Conclusions: No negative impact from desflurane removal has been reported. Equipment for TIVA use including bispectral index (BIS) monitoring is now widely available in our department. Next steps include re-auditing and comparing pharmacy procurement data from 2019 to 2022. We are looking to expand our ‘greener’ movement into re-capturing N2O and improving recycling methods. 1.England.nhs.uk. 2021. Delivering a ‘net zero’ national health service. Available at: https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf (accessed 25 March 2022)2.Pierce J. The environment, the gas bill and the route to sustainable anaesthesia. Rcoa.ac.uk. 2013. Available at: https://www.rcoa.ac.uk/sites/default/files/documents/2019-09/Bulletin82-Nov2013-Pages39-41.pdf (accessed 25 March 2022).
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