Anesthesiologists Tackle Climate Change in the OR

It takes all of us to combat climate change. Even anesthesiologists.

“As someone who values making eco-friendly choices, I was shocked to learn that my use of anesthesia gases during just one operation can be like driving a car 2,000 miles,” says anesthesiologist Holden Groves, MD, assistant professor of anesthesiology at Columbia University Vagelos College of Physicians and Surgeons. “Anesthesia gases are greenhouse gases and reducing their use is crucial for the environment and the anesthesia profession.”

Groves and his team have been working successfully to reduce Columbia's contribution to greenhouse gases by changing the anesthetic gases they use and reducing the amount used during each procedure.

You may never remember meeting your anesthesiologist, but the work he or she does ensures you are safe and comfortable during surgery.

Anesthesia gases are a critical tool, but they also play a significant role in making the health care industry the world’s fifth largest emitter of greenhouse gases. Emissions of anesthetic gases in the United States alone are estimated to equal the annual emissions of one coal-fired plant, or nearly 1 million automobiles per year.

The anesthetic agents in use today contribute in varying degrees to the carbon footprint of anesthesiology practice. The anesthetic desflurane, for example, is a commonly used gas that is 2,540 times more potent than CO2 in trapping heat in the atmosphere. “Just a little bit of desflurane can have an enormous impact,” says Groves.

Learning stats like that inspired anesthesiologist Nicholas Gadsden, MD, a postdoctoral residency fellow in anesthesiology at Columbia with a passion for sustainability, to help shrink his profession’s footprint. “It was a natural evolution of my personal efforts to combat climate change to bring that energy into my workspace,” Gadsden says.

To create meaningful change on a departmentwide and enterprisewide scale, Groves, Gadsden, and other Columbia anesthesiologists addressed their field’s biggest offenders: inhaled anesthetic agents, especially desflurane, which contributes the same greenhouse gas emissions during a five-hour surgery as the 2,000-mile car trip. Choosing an alternative anesthetic inhalational agent, sevoflurane, for the same surgery is equivalent to a 75-mile drive. This change to sevoflurane does not compromise patient safety or care.

In the past few years at Columbia, the switch to alternative anesthetics has reduced the use of desflurane from about 800 liters a month to 50 liters a month, says Gadsden, significantly reducing the anesthesiologists’ carbon footprint.

Columbia anesthesiologists are also working to reduce the quantity of inhalational agents used in every surgery. An automated alert system, integrated into the electronic medical record at every anesthesiologist’s computer workstation, helps anesthesiologists minimize waste during the delivery of inhalational agents. The Columbia team's next target: reducing nitrous oxide waste.

Gadsden says that interdisciplinary collaboration with surgical and nursing colleagues across the perioperative space is instrumental to the ongoing success of the Columbia effort.

“But there are many small decisions that all anesthesiologists can make during their day-to-day practice to minimize the carbon footprint of their practice without compromising patient safety or care,” he adds.

“Increasing awareness is the first step.”