Changing the anesthesia gas would have no impact on patients, the INESSS says.
A Quebec government agency is recommending that the health network stop using a gas with a large carbon footprint for general anesthesia during surgeries.
General anesthesia consists of putting the patient to sleep, among other things, with an inhaled gas before a surgical operation.
The choice of an anesthetic agent is made based on its clinical performance and its safety profile, which are defined based on its diffusibility and its potency. Anesthesia using desflurane gas has a carbon footprint about 40 times higher than sevoflurane, when taking into account its potency and the 20-year global warming potential, or GWP-20.
According to the Institut national d’excellence en santé et en services sociaux (INESSS), changing the anesthesia gas would have no impact on patients, so it recommends the elimination “except in very exceptional situations” of the use of desflurane.
“In 2023, even if the number of hours of general anesthesia associated with desflurane represented only three per cent of the total number of hours of anesthesia associated with halogenated agents, it generated 51 per cent of tonnes of CO2 equivalent associated with these agents,” the INESSS writes in its opinion.
In an environmental context, anesthesiologists are increasingly questioning the use of desflurane and nitrous oxide due to their high carbon footprint.
Nitrous oxide is a carrier gas that can be used during anesthesia. It has a lifespan of 109 years in the atmosphere. This gas can accelerate the speed of induction and the patient’s awakening, but its use should be practically abandoned, according to INESSS, which recommends closing centralized nitrous oxide distribution systems by ceasing the supply to the pipes. It also advises not to involve this type of system in the construction plans of future hospitals.
The shift in anesthesia practices has already begun in Quebec. The number of bottles of desflurane supplied to operating rooms decreased by around 80 per cent between 2019 and 2023.
The proportion of hours of inhalation anesthesia with desflurane fell from 16 per cent in 2019 to three per cent in 2023, according to INESSS calculations, lowering the carbon footprint from this anesthetic agent to the equivalent of 5,943 tonnes of carbon dioxide in 2023, down from 31,959 tonnes in 2019.
Furthermore, the gradual replacement of desflurane with sevoflurane could save $204,400 over three years. In an email sent to The Canadian Press, INESSS said it was confident of a secure supply with three potential suppliers of sevoflurane.
“The risk of absolute shortage of this product is low,” it says, adding that there are other methods of intravenous general and locoregional anesthesia.
The Ministry of Health and Social Services has given INESSS the mandate to formulate recommendations on the best clinical practices to reduce the carbon footprint of general inhalation anesthesia without compromising the safety of care. The ministry made the request following a request from Quebec’s association of anesthesiologists.
In Quebec, the health sector generates 3.6 per cent of the province’s GHG emissions. Of its health GHGs, three per cent comes from the use of inhalation medications in the treatment of chronic lung diseases and anesthetic gases used mainly in the operating room.
Despite a rather minimal impact on overall GHG emissions in Quebec, the changes in anesthetic products will contribute to the health ministry’s objective of greening practices in the operating room, and more broadly to achieve carbon neutrality in Quebec by 2050.
To achieve concrete results, INESSS says the Ministry of Health should remove desflurane from the provincial list of medications for health establishments.
Hospitals and other facilities should gradually return desflurane-compatible vaporizers and cassettes by the end of current leases. Establishments would also benefit from having an action plan to reduce the carbon footprint of anesthetic gases, in particular by monitoring the consumption of inhaled anesthetic agents and compiling the medical reasons justifying the exceptional use of desflurane.
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