To tackle the climate emergency we must transform anaesthetic practice

Published: 29/10/2021

Calls for a switch to less impactful anaesthetic gases ahead of COP26

Ahead of the 2021 United Nations Climate Change Conference being held in Glasgow, the Royal College of Anaesthetists is calling on NHS hospital Trusts, Boards and anaesthetic departments to increase their efforts to reduce the use of environmentally-damaging anaesthetic gases and switch to more sustainable options in the fight to combat the climate emergency.

Huge strides have been taken by hospitals across the country to reduce the use of harmful anaesthetic gases, with the NHS reaching its target to reduce desflurane to below 10% of all volatile gas use and some hospitals eliminating its use completely. Many hospitals have also taken on the mantle of educating their colleagues on the environmental damage caused through the choices they make in their professional and personal lives.  However, more must be done if the NHS is to reach its target of net zero by 2040.  

The NHS accounts for 40% of all public sector carbon emissions in the United Kingdom, with anaesthetic gases representing 5% of the carbon footprint from acute NHS organisations1 and 2% of all NHS emmissions2. Just one hour of surgery using nitrous oxide is the equivalent of driving 106km, with the anaesthetic gas desflurane being 2,500 times more warming than carbon dioxide. In comparison, by switching the gas to sevoflurane, an hour's anaesthetic is only the equivalent of driving 5 –10km3.

The College also provides examples in its sustainability strategy4 showing hospitals and anaesthetic departments not only how to switch anaesthetic gases but also how to innovate their practices. This includes increasing the use of total intravenous anaesthesia and delivering more operations as day procedures using regional anaesthesia, which has the added benefit of freeing up beds and increasing capacity.

Dr Lucy Williams, Royal College of Anaesthetists Council Lead for Sustainability, said:

“Meeting environmental targets will take a significant transformation in anaesthetic practice, from choosing the anaesthetic gas with the least impact on the carbon footprint to increasing recycling to changing surgical practice. While there have been huge strides made in many hospitals, and I am incredibly proud of how our speciality has stepped up in the face of this unprecedented environmental challenge, the hard truth is that we haven’t gone far enough.

“We must remember that every operation requires electricity, every piece of equipment, every drug and every gas, requires energy to develop, produce and transport. This is before we consider the environmental impact of packaging, staff travel and low recycling rates.

“The NHS produces higher emissions than the global average for healthcare5 and anaesthetic departments remain a key contributor to their global footprint.  The NHS will never reach its target of net zero without all anaesthetic departments recognising the need for change and taking responsibility for the environmental impact of their clinical practice.

“It is easy to see introducing these changes as being a burden on services, but far from it. By streamlining the way we deliver anaesthetic care, through initiatives such as increasing day surgery or choosing wisely to reduce unnecessary medical tests, treatments, and procedures, we can increase NHS capacity, whilst not compromising the safety of our patient. Similarly, by introducing simple sustainability programs that reduce paper use or by increasing video conferencing to avoid unnecessary vehicle journeys for staff, there can be significant financial gain in the long run. Being environmentally sustainable is not only the right thing to do for our planet and the health of the population but also an important way to improve NHS services.

“By all of us in the NHS working together, we can help tackle the climate ‘health emergency’ and deliver a more environmentally sustainable future, whilst continuing to provide the best care for our patients”

Reference:

  1. The Lancet Countdown on Health and Climate Change: Policy brief for the UK – December 2020
  2. Putting anaesthetic-generated emissions to bed – NHS England, September 2021
  3. Your anaesthetic and the environment – RCoA resources
  4. RCoA Sustainability Strategy 2019-2022
  5. Health Care’s Climate Footprint – Health Care Without Harm, September 2019