Minimising the usage of desflurane only by education and removal of the vaporisers - a before-and-after-trial.

Abstract

Background: By exceeding planetary environmental boundaries, multiple global crises have become imminent in the 21st century. The healthcare system is a contributor to the climate crisis, accounting for approximately 5% of greenhouse gas emissions in Western countries. In anaesthetic clinics, desflurane, a highly potent greenhouse gas and volatile anaesthetic with no compelling indications, accounts for up to two thirds of total emissions. Its use can be drastically reduced using simple measures. In the present study, we investigated whether a relevant and timely reduction in use could be achieved by dismounting desflurane vaporisers and providing information to the team without restricting its use.

Methods: The study was conducted in a German university hospital with approximately 1250 beds, over a 12-month period between 2021 and 2022, with a comparison to the corresponding periods of the previous years up to 2017. The interventions were, first, the removal of desflurane vaporisers, and second, staff education on the climate impact of volatile anaesthetics. The primary outcome variable was the reduction of hypnotic-related emissions in CO₂ equivalents per anaesthetic procedure.

Results: Prospective data collection and interventions were conducted from 28 March 2021 to 27 March 2022. The amount of CO₂ equivalent emissions per procedure in the form of volatile anaesthetics was reduced by 86% compared with the year before the interventions (p < 0.001). Interestingly, there was already a 52.1% reduction in the year before the procedure (p < 0.001). There were no significant changes in the use of sevoflurane or propofol. Hypnotic-related costs decreased by €14,549, whereas extubation time did not change significantly.

Conclusions: Removal of desflurane vaporisers and staff training can quickly and significantly reduce the emissions of an anaesthesia department in a large German teaching hospital. This may also reduce the costs.

Trial registration: The trial was registered with the German Clinical Trials Register, identifier DRKS00024973 on 12/04/2021.