Strategic anesthetic selection reduces environmental impact, costs

The UNMC Department of Anesthesiology has greatly reduced its use of an anesthetic gas with negative environmental impacts, a tactic that will save approximately $376,000 annually.

The effort was sparked by Megan Chacon, MD, anesthesiology’s director of global health. She first noticed opportunities for more environmentally friendly practices in operating rooms, such as a better workflow to recycle the sterile plastic packaging discarded while nurses and anesthesia teams prepare the OR for surgery. As Dr. Chacon researched possible solutions to achieve these goals, she came across an environmental nemesis: desflurane.

Anesthetic gases are known greenhouse gases. Desflurane, one of the three most common inhaled anesthetics, is used for maintenance of general anesthesia. However, it has approximately 50 times the global warming impact than other anesthetic gases. For example, one hour of desflurane use has approximately the same environmental impact as driving 155 miles and costs $12. Using another common inhaled anesthetic, sevoflurane, in the same manner is like driving three miles and costs $3.

"I realized that if I am a person who is passionate about climate change, and I didn’t know desflurane has a significantly higher environmental impact than other anesthetics, there were likely many others in the department who didn’t know either," Dr. Chacon said.

Dr. Chacon began by educating the department on desflurane’s environmental impacts. Key stakeholders in clinical and pharmacy realms joined the initiative. After evaluating usage and purchasing data, the team determined it best aligned with Nebraska Medicine’s values to greatly reduce the amount of desflurane vaporizers and gas available. A small number of desflurane vaporizers and gas remain available for check out in all operating room sites if the clinical situation warrants the use of desflurane, or for educational purposes.

"As a department, we always try to be curious when faculty raise questions regarding the quality or value of our anesthetic practices," said Steven Lisco, MD, anesthesiology chair. "In this case, Dr. Chacon raised an important question that inspired our department and perioperative services to truly think outside the box and innovate in a way that created a true win-win for both UNMC and Nebraska Medicine. The entire department can be proud of this ITEACH moment."

"The work the department of anesthesiology has done, not only as good stewards to the environment, but also ‘thinking like an owner’ with reducing use of this specific anesthetic gas is just another example of our colleagues living our ITEACH Values, especially the innovation and accountability values in this instance,. I encourage everyone at Nebraska Medicine to adopt this thinking,"  said Nebraska Medicine CEO Jim Linder, MD.