Can anaesthesia help reduce the carbon footprint of surgery?

11 Jul 2024 6min read

In recent years, the commitment to sustainability has become an integral aspect of modern medical practice, particularly with the NHS aiming to reach net zero by 2040. With surgical procedures accounting for approximately 25% of the carbon footprint produced by the NHS and anaesthesia being an integral part of almost every operation, there is no surprise that this has become an area of focus for those invested in making the medical industry greener.

Why is anaesthesia important?

Anaesthesia may be taken for granted today, however its introduction paved the way for much of modern surgery. The experimentation with plants and chemicals for their anaesthetic properties in the 1850s led to a revolution in surgical treatments. Surgery quickly changed from being a painful last resort to a planned, elected treatment that could cure and prevent serious illness. With this shift, the complexity of surgery evolved, as surgeons could begin to take their time and experiment with new techniques. This directly led to some of the most major advancements in healthcare, including organ transplantation, minimally invasive surgery and surgical robotics. Such advancements in both pain relief and surgical technology have led to an increase in surgery being used as an elective treatment and as a result a significant improvement to public health and worldwide life expectancy.

Despite its benefits, in recent years many leading anaesthetists have realised that their go-to drugs have unfortunately also been contributing to the climate change crisis.

What is the carbon footprint of anaesthesia?

The more commonly used inhaled drugs for anaesthesia in general surgery such as isoflurane, sevoflurane and desflurane are halogenated chlorofluorocarbons or fluorinated hydrocarbons. These are collectively known as halogenated agents and have variable but often large global warming potential (GWP).  As can be seen in Table 1 below, which lists the GWP for using these specific inhaled drugs for 1 hour, these common anaesthetic drugs can have a significant carbon output.

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How can the impact of anaesthesia usage be reduced?

Some anaesthetists have been making the decision to seek out drugs that can provide the numbing effects needed by their patients but that have lower global warming potential. For instance, swapping desflurane for sevoflurane reduced the global warming impact from 254 GWP to 130 GWP.  That is a decrease of nearly 50% for a procedure that is required in almost every operation undertaken in the NHS. However, the anaesthetic potency of sevoflurane is considerably less then desflurane, meaning the anaesthetist needs to supply the patient with a higher volume of the gas over the course of an operation. The risk-to-benefit ratio for both the environment and the patient need to be considered when making decisions such as this to substitute products.

This is the case in other areas of the hospital as well. For instance, Entonox, commonly known as gas and air, is a mixture of N2O and O2 traditionally used to ease pain and trauma for women during labour. Entonox has a GWP of approximately 265 and is labelled as a greenhouse gas. As a result, it has come under the spotlight recently for the potential effects that a build-up of this gas may be having in maternity wards on both patients and staff.

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To further explore how the NHS is aiming to reduce the carbon footprint of anaesthesia in surgery, I spoke with Dr. Katy Whitehouse, a consultant obstetric anaesthetist at the Newcastle upon Tyne Hospitals NHS Foundation Trust. Dr Whitehouse is aware of this affect and is passionate about reducing the environmental impact that her own methods have.

“The climate crisis is one of the biggest threats to the health of our population and everybody has a role to play in doing their part to help reduce the environmental impact of their activities. If I can influence a small handful of people and they can do the same, then we will start to make a big difference – a little can go a long way.” said Dr Whitehouse.

Dr Whitehouse believes that removing Entonox altogether without a reasonable alternative method of pain relief will cause patients undue stress and pain, which is why she has begun to champion a shift to total intravenous anaesthesia (TIVA) in all areas of the hospital, not just the maternity ward.

TIVA is a method that uses drugs like Propofol which are supplied in liquid form and are administered directly into the blood stream. So, they are not volatile substances with the ability to leak into the atmosphere, meaning they have a reduced environmental impact. This method is now the go-to choice for many anaesthetists, including many newly qualified doctors, as there is also evidence of fast post-operative recovery when using TIVA. Dr Whitehouse says the following about this choice:

“I can choose to use less environmentally harmful anaesthetic agents and have been involved in a large project to reduce the impact of nitrous oxide when used as a labour analgesic, whilst still ensuring that women have access to this. We should be embracing technological advances to help us, not limiting the choices offered to our patients.”

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Achieving a balance between effective healthcare and sustainability

The evolution of anaesthesia remains a testament to the remarkable journey of modern medical science. However, as the world deals with the environmental repercussions of medical practices, it is becoming increasingly important to scrutinise the ecological footprint of practices such as anaesthesia.

The efforts from practitioners to transition to less environmentally impactful drugs and methods reflect a much-needed commitment to balancing medical progress with environmental responsibility.

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