Research

Inhalational anaesthetic agents absorb infrared radiation and thereby contribute to anthropogenic global warming by radiative forcing. These gases account for 5% of the acute National Health Service’s (UK) carbon footprint and have extended atmospheric lifetimes. The 20-year global warming potential of the inhalational agents desflurane and sevoflurane are 5,513 times and 796 times greater than an equal mass of CO2 respectively. This project reviewed the inhalational anaesthetic ordering practices at Wagga Wagga Base Hospital between 1st June 2016 and 30th June 2021 and examined the trends in use, expenditure and global warming potential. During this time the number of sevoflurane and desflurane bottles per year changed from 371 ($54,162) to 550 ($55,000) and 114 ($27,270) to 12 ($2,916) respectively. The order volume of desflurane reduced dramatically after the clinician-initiated removal of vaporisers from the ventilators in August 2019. Despite this, due to system errors, further desflurane was habitually ordered accounting for the 12 bottles in 2020/21. Desflurane represents an arguably obsolete inhalational anesthetic with negative impacts on patients, the planet and public’s purse. This aggressive approach to volatile minimisation was effective in reducing desflurane use at Wagga Wagga Base Hospital and may represent a proof of concept for broader application in other healthcare institutions. Future areas of quality improvement include inventory and disposal procedures to prevent future re-ordering of largely decommissioned volatile gases and minimise the environmental impact of used (and unused) gas bottles.

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