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How switching anesthetics can have a massive impact on a hospital's carbon footprint

Study published by two Health Sciences North physicians highlights the surprising way hospitals are contributing to greenhouse gas emissions

The operating room is the largest contributor to greenhouse gas emissions in the health care industry, said a local physician, who is a leading voice on encouraging hospitals to go green. 

Desflurane, a common anesthetic gas used every day to put people to sleep before surgery in hospitals everywhere, is a major contributor to the carbon footprint of a hospital, said Dr. Sanjiv Mathur, a physician with Health Sciences North.

Along with Dr. Antonio Caycedo, a surgeon at HSN, they published a paper in the Canadian Journal of Anesthesia comparing the use of Desflurane and Sevoflurane, another anesthetic gas with a smaller carbon footprint. 

They conducted the study after the Canadian Medical Association, in the Lancet Commission, asked for physicians to look at their own work places and see how they could reduce greenhouse emissions.

The study was conducted over an 18-month period on the carbon footprint of the anesthetic gases in a particular cancer surgery.

“As it turns out, the gases that we use to keep patients asleep are very potent greenhouse gases,” said  Mathur. “We showed that over the course of the surgery, one anesthetic agent (Desflurane) had a much greater carbon footprint than the other anesthetic gas (Sevoflurane).”

To put it in context, using Desflurane in one surgery is equivalent to driving a vehicle 1,600 kilometres. Whereas, if you use Sevoflurane, it was equivalent to driving the vehicle 33 kilometres, Mathur said.

In 2016, Mathur and Caycedo looked at a full year of the carbon footprint of Desflurane versus Sevoflurane at Health Sciences North.

“Our Desflurane use in 2016 was the equivalent of driving a car 3.2 million km,” Mathur said. “That's driving to the moon and back four times.”

Compare this to an equal amount of Sevoflurane, and it would be like driving a car 132,000 km, Mathur said.

“Our data also shows that if an anesthesiologist converts from Desflurane to Sevoflurane, they can reduce their environmental impact by 105 tonnes every year. This is the personal contribution of more than 10 Canadians.”

And for those who believe that patients will wake up quicker with Desflurane, Mathur said their study concludes that isn't the case.  

In this study, Mathur said he and Caycedo measured how fast the patient woke up and met the criteria to be discharged to the floor — a real time measurement of whether or not the patient is waking up more quickly. 

They found there was no significant difference. The patient did not wake up any quicker, and did not get discharged to the floor any sooner between the two anesthetics. 

“There are certain scenarios where some people find Desflurane has advantages in certain select patients, but, in general, the sales of Desflurane have gone down since we've come forward on this kind of research,” Mathur said. 

The idea of switching gases has been met with support, Mathur said. In fact, the majority of anesthesiologists at HSN, after reviewing the data, decided to not use Desflurane at all in the future.

Mathur said he has presented his study at many hospitals already. Montreal hospitals have a keen affinity for Desflurane, because they still believe it may be superior for elderly patients and how fast they regain their mental capacities after an anesthetic.

“As you can imagine, if you're in your 80s and you get these potent drugs, you can take some time to recover. However, I know the province of Quebec takes the environment more seriously than most provinces. I feel that if we get this information out, like what we just published, people may change their minds.”

Patients, too, have already expressed interest in going with Sevoflurane over Desflurane, Mathur said. 

“We actually have had a few patients who have read these studies, or looked at some of the media that's come around this, and they are asking whether they could have Sevoflurane because they have concerns about their carbon footprint.”

There's also a cost savings involved, as Sevoflurane is a bit cheaper than Desflurane, Mathur said. 

Furthermore, when using Desflurane, the vaporizer used to administer the gas has to be plugged in and the gas warmed, which is something Mathur said he and Caycedo haven't taken into consideration in their calculations.

Changing from Desflurane to Sevoflurane is a great example of how physicians and health-care workers can look within their own environments and see ways to reduce their carbon footprint and emissions without affecting patient care, Mathur said.

Mathur's article has already been published online, and the hard copy will be on shelves in a few months.


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Arron Pickard

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