Environmental harm is probably the last thing on a patient’s mind when being put to sleep before surgery.
But for the anesthesiologist who administers the medication, it can be near top of mind.
“As an anesthesiologist, I’m well aware of the carbon footprint and the environmental impact of our operating rooms, in particular, the use of anesthetic gases,” said Dr. James Norris of Fredericton.
“People may not realize that anesthetic gases are potent greenhouse gases, much more significant than carbon dioxide.”
But operations must go on, said Norris, and there are ways to reduce the carbon footprint of the health care system.
Norris, who works at the Dr. Everett Chalmers Regional Hospital, said that two equally efficient anesthetics have dramatically different environmental impacts.
He decided to halt the hospital’s use of desflurane, which has been used for years in operating rooms, in favour of sevoflurane, the environmentally friendlier option.
Norris said when people exhale under anesthesia, that gas is vented into the air.
But desflurane will persist for 14 years in the atmosphere, while sevoflurane lasts for one.
Norris said one hour’s worth of anesthesia with desflurane is equivalent to the carbon dioxide produced from driving a car for 320 kilometres. The same amount of sevoflurane is comparable to driving for 6.5 kilometres, he said.
Norris said the main difference between the two, when it comes to how they work, is that desflurane wears off a little quicker than sevoflurane. But that can easily be dealt with by turning down the sevoflurane anesthetic a little sooner.
Although most anesthesiologists have switched to using sevoflurane primarily, said Norris, it occurred to him in the last little while that the Chalmers hospital still stocked desflurane.
So, he and a group of others at the hospital put a hard stop on stocking it, and the hospital is working to properly dispose of the remaining bottles.
That makes the Chalmers the first in the province to stop stocking desflurane. Horizon and Vitalité health networks both confirmed this. A Vitalité spokesperson did say sevoflurane is the most widely used anesthetic for the network, however, desflurane is kept and used in smaller quantities.
Norris said he suspects other hospitals will follow suit once they realize how simple it is to just remove it from their stock.
“I think if we can encourage conversation, that’s the first step,” he said.
Some other hospitals in Canada have also discontinued desflurane.
Fiona Miller, a professor of health policy at the University of Toronto and director of the Collaborative Centre for Climate, Health and Sustainable Care, said nearly five per cent of Canada’s greenhouse emissions are from the health care sector.
“Health care is a remarkably resource intensive and polluting service industry,” she said.
Miller said the vast majority of health care emissions come from products and services, such as pharmaceuticals, devices and supplies.
When it comes to anesthetic gasses, she said they are high- polluting, and they are considered to be “direct emissions” because the harm is happening directly in surgical suites, as opposed to production plants.
Miller said one of the other things that makes anesthetic gas such a huge issue is that there are alternatives.
“High-quality care and safe care can absolutely be maintained by switching, by changing practices,” she said, using the switch from deflurane as one example.
With simple changes in the area of anesthesia, Miller said somewhere in the region of five per cent of health care emissions can be cut.
She said more hospitals are making the change because there are clinically appropriate and safe alternatives at the ready.
“There’s a whole slew of improvements that are possible in perioperative care, but anesthetic gasses are a really low hanging fruit in that sense.”
Norris said he first got interested in the environment aspect of health care about five or six years ago.
“I have young children. And so with children, you tend to think about the future more and what we’re going to leave them as a planet. So that’s when I became interested in exactly what I can do as a professional to improve the environment,” he said.
Norris chairs the Fredericton hospital’s environmental stewardship committee, which he said is where the conversation to discontinue desflurane flourished.
He said it’s encouraging to him that so many people at the hospital have an interest in making it greener.
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Norris said he wants New Brunswick to become a leader in green health-care delivery.
The stewardship committee has also discussed solutions such as electric vehicle charging stations, bike racks and a formal recycling program, he said.
“I truly believe that small things like that can make a big difference and can encourage other people to follow suit, and hopefully have a big difference overall.”
This story was originally published in CBC News on Dec. 18, 2023.
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