A quality improvement project by SKH Anaesthesiology aims to reduce the carbon emissions from anaesthesia by reducing monthly use of desflurane by 50% in 6 months.
Aim
Climate change is one of the greatest challenges facing our planet today. Healthcare plays a significant role in contributing to global warming (4.4% of global emissions). Of this, anaesthesia gases are estimated to make up 5% of greenhouse gas emissions. Of all the anaesthesia gases in use, Desflurane has the most global warming potential.
As anaesthestists, our responsibilities lie not only with the patients on our operating tables but also with future generations. To that end, we implemented a quality improvement project with an aim to reduce the carbon emissions from anaesthesia by reducing monthly use of desflurane in SKH by 50% in 6 months.
We believe that the benefits of reducing desflurane use would not only include reduced environmental pollution and contribution to global warming, but also cost savings for the hospital as well.
Methods
Starting from December 2021, we placed posters on the anaesthetic machines and in prominent locations frequented by anaesthetists in SKH. These posters highlighted the greater global warming potential of desflurane and encouraged SKH's anaesthetists to use less desflurane. The availability of desflurane refills was also changed from "always available" to "available on demand". To assess the efficacy of our intervention, we compared the change in global warming potential (equivalent CO2, eCO2) and cost per hour of general anestehsia (GA) over a 3-month period prior to the intervention (September - November 2021) and a 2-month period after the intervention (January - February 2022).
Results
We found that the mean global warming potential per hour of GA time (eCO2/h) reduced by 45% from 39.17kg CO2 to 20.69kg CO2, while the mean monthly global warming potential was reduced by 8415 kg CO2 compared to the pre-intervention baseline. The mean cost of volatile agents per hour of GA time went down from $23.04 to $16.82 in February, resulting in mean monthly savings of 27%. The monthly use of desflurane decreased from an average of 39 bottles in the pre-interventional baseline period (September - November 2021) to 25 bottles in February 2022 (35% reduction).
Conclusion
Our project has demonstrated clear reduction in SKH's contribution to global warming with the added benefit of cost savings. If trends persist, we expect an annual reduction of about 45% of eCO2 and an annual cost savings of around 30%.
Desflurane: 1 bottle: 240 mls, 886 eCO2, $324.10 (SKH cost)
Sevoflurane: 1 bottle: 250mls, 44 eCO2, $285.30 (SKH cost)
References
1. Yasny JS, White J. Environmental implications of anesthetic gases. Anesth Prog. 2012;59(4):154-158. doi:10.2344/0003-3006-59.4.154
2. Gadani H, Vyas A. Anesthetic gases and global warming: Potentials, prevention and future of anesthesia. Anesth Essays Res. 2011;5(1):5-10. doi:10.4103/0259-1162.84171
3. Varughese, Shane MD; Ahmed, Raza MD Environmental and Occupational Considerations of Anesthesia:A Narrative Review and Update, Anesthesia & Analgesia: October 2021 - Volume 133 - Issue 4 - p 826-835 doi: 10.1213/ANE.0000000000005504
Team lead: Dr Shariq Ali Khan
Team members: Drs Lim Wan Yen, Lathiga, Kevin Seah, Malvine Phua
AU nursing sisters: Loy Ying Hao, Nuraida Binte Adenan