Avoid common mistakes on your manuscript.
To the Editor,
Climate change has been recognized as a significant global health threat, with recent reports from the Intergovernmental Panel on Climate Change predicting that global warming will exceed 1.5°C by 2040.1 Currently, Canada has the third-highest per-capita health care-associated emissions, which account for 4.6% of our national emissions.2
Numerous contributions to the anesthesia literature, including a dedicated Special Article by Rübsam et al. in this issue of the Journal,3 have recognized the harmful emissions produced by desflurane and have called for its limitation or even elimination. Desflurane has a global warming potential over 100 years (GWP100) of 2,540 and atmospheric lifespan of 14 years, whereas sevoflurane has a GWP100 of 130 and atmospheric lifespan of one year.4 When used at the same fresh gas flow for the same length of time, desflurane has been shown to release 50 times the carbon dioxide equivalents of sevoflurane. In addition to environmental benefits, sevoflurane is often cheaper. Reducing desflurane has been associated with savings of as much as USD 25,000 per month, as reported by the University of Wisconsin.5 Given the harms of desflurane, some Canadian institutions, including in London, Vancouver, and Toronto have begun to phase down its use, while other systems such as Health Sciences North in Sudbury, Ontario, or the Yale-New Haven Health System in the USA have eliminated it entirely from their hospital formularies. Nonetheless, efforts in Canada to reduce desflurane are currently neither widespread nor coordinated.
Reducing desflurane use can be challenging when there are established practice patterns, limited resources, or competing priorities. To help alleviate some of the initial work in promoting volatile agent change, we have created a Greener Gases Starter Pack that contains the resources developed by the Greener Gases project at McMaster University. This project was publicly launched in February 2021, supported by the Canadian Federation of Medical Students Project Green Healthcare program. Although we are still in the first year of project implementation and data collection is still currently underway, the urgency of climate action compels us to share the resources we have developed to help Canadian health care institutions shift to reduce desflurane use.
The project was based on the success of a similar project at the University of Wisconsin that reduced the average per-case emissions by 64% through a combination of provider education and point-of-care labels.5 As such, our starter pack includes a white paper of up-to-date evidence, a PowerPoint (Microsoft Corporation, Redmont, WA, USA) presentation introducing the project, anesthetic machine labels, and infographic posters. The package also includes a provider survey to help evaluate attitudes, knowledge, and beliefs pre and post intervention, as well as an easy-to-read narrative guide describing tips, recommendations, and lessons learned. The starter pack can be found at the Greener Gases website: http://www.greenergases.ca/. Users are encouraged to adapt resources to their local needs as well as share their resources on this platform.
In releasing this starter pack, we recognize that reducing desflurane use is only the first step to improving anesthetic sustainability. Other simple but high-impact strategies include the consistent use of low fresh gas flow (< 1 L·min–1) anesthesia as well as minimizing nitrous oxide (N2O), a potent ozone-depleting agent. Recent correspondence by Hönemann et al. in the Journal highlight alternatives to N2O in pediatrics and obstetrics, which they have used since their elimination of N2O since 2003.6 Furthermore, installation of desflurane capture and recycle technologies and an increase in total intravenous anesthesia and regional technique use can further improve sustainability in practice. A comprehensive list of recommendations can be found at the American Society of Anesthesia’s Greening the Operating Room guidelines.7
References
Intergovernmental Panel on Climate Change. Climate change 2021: the physical science basis, 2021. Available from URL: https://www.ipcc.ch/report/ar6/wg1/#FullReport (accessed June 2022).
Eckelman MJ, Sherman JD, Macneill AJ. Life cycle environmental emissions and health damages from the Canadian healthcare system: an economic-environmental-epidemiological analysis. PLoS Med 2018; 15: e1002623. https://doi.org/10.1371/journal.pmed.1002623
Rübsam ML, Kruse P, Dietzler Y, et al. A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint. Can J Anesth 2023; this issue. https://doi.org/10.1007/s12630-022-02393-z
Andersen MP, Nielsen OJ, Karpichev B, Wallington TJ, Sander SP. Atmospheric chemistry of isoflurane, desflurane, and sevoflurane: kinetics and mechanisms of reactions with chlorine atoms and OH radicals and global warming potentials. J Phys Chem A 2012; 116: 5806–20. https://doi.org/10.1021/jp2077598
Zuegge KL, Bunsen SK, Volz LM, et al. Provider education and vaporizer labeling lead to reduced anesthetic agent purchasing with cost savings and reduced greenhouse gas emissions. Anesth Analg 2019; 128: e97–9. https://doi.org/10.1213/ane.0000000000003771
Hönemann C, Kim SC. Please stop using nitrous oxide in routine clinical practice (comment on: Use of nitrous oxide in contemporary anesthesia-an ongoing tug of war). Can J Anesth 2022; 69: 271–2. https://doi.org/10.1007/s12630-021-02136-6
American Society of Anesthesiologists. Greening the operating room and perioperative arena: Environmental sustainability for anesthesia practice, 2014. Available from URL: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room (accessed June 2022).
Disclosures
None.
Funding statement
Canadian Federation of Medical Students - Project Green Healthcare grant for Greener Gases project.
Editorial responsibility
This submission was handled by Dr. Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
He, H., Ge, F.Z., Ly, O. et al. Greener Gases Starter Pack: a tool for transitioning to more sustainable anesthetic volatile agents. Can J Anesth/J Can Anesth 70, 445–446 (2023). https://doi.org/10.1007/s12630-022-02394-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12630-022-02394-y