How some doctors want to cut greenhouse gas emissions in the operating room

In the moments before a patient undergoes surgery, chances are climate change isn’t top of mind.

Yet, the anesthetic gases used to put them to sleep leave a big carbon footprint.

In the May online issue of the Canadian Journal of Anesthesia, Dr. Timur Ozelsel, an anesthesiologist at the University of Alberta Hospital in Edmonton, estimates that the emissions impact of using a popular anesthetic called desflurane over the course of a single day in one operating room would be equivalent to driving anywhere from 2,500 to 16,000 kilometres.

“It would be like driving from the capital of Norway all the way down to Cape Town, South Africa,” he said.

Still, some doctors aren’t aware of the problem or what they can do to help solve it — and some of their colleagues in the field say it’s time to change that. 

“It’s a gas that we use every day in the operating room and actually it’s an invisible problem to most of my colleagues,” said Dr. Nam Le, an anesthesiologist at Mount Sinai Hospital in Toronto.

A look at some anesthetic gas products. Sevoflurane, right, lasts about a year in the atmosphere, while desflurane, centre, lingers roughly 14 years. (Craig Chivers/CBC)

The drugs he’s referring to are sevoflurane and desflurane. Both have been a mainstay in operating rooms for decades. Le said there is little difference between them as anesthetics, except that desflurane costs about twice as much and allows the patient to wake up a bit faster.

The difference between the two gases in terms of their environmental impact, on the other hand, is significant.

Sevoflurane lasts about one year in the atmosphere before it dissipates. Desflurane lingers roughly 14 years and traps five to 20 times more heat.

Normally about 95 per cent of the anesthetic agents given to a surgical patient end up wasted in the environment, says Ana Lopez Filici, manager of anesthetic clinical services at the University Health Network in Toronto. (Craig Chivers/CBC)

So why is desflurane still being used in the operating room? Ozelsel says it may simply be a matter of habit.

“If you’ve been using these [gases] for the last 15, 20 years, you’ll be worried about trying something new,” he said. “You might be worried that you’re not doing justice to your patient and not providing them the best care that you possibly can.”

That’s something Ozelsel, Le and others are trying to change. While patient safety is always a top priority, it doesn’t actually take much anesthetic to put someone under.

“Only about five per cent [of the gas] gets absorbed by the patient,” said Ana Lopez Filici, manager of anesthetic clinical services at the University Health Network (UHN) in Toronto. “About 95 per cent of the anesthetic agents actually leave the patient and are delivered into the environment.”

To stop that release of emissions, UHN hospitals have partnered with Blue Zone, a company based in Concord, Ont., about 45 kilometres north of Toronto. The filter technology allows anesthesia technicians to capture the extra gas exhaled by a patient during surgery and direct it to special canisters.

Sustainable alternative

The canisters go back to Blue Zone, where the gas that’s been captured is liquefied to be used as a raw material to produce new generic anesthetics, said Dusanka Filipovic, who founded the company 20 years ago.

The Blue Zone technology is currently being used in about 20 per cent of operating rooms across Ontario. The service costs UHN about $15,000 per year.

Ozelsel says medicine needs to go further to combat climate change, which the World Health Organization has called the greatest threat to global health in the 21st century.

“We really have to start regulating ourselves within medicine and start, for example, reporting our greenhouse gases,” he said.

In Alberta, for example, there’s a new initiative where patients will be asked if they’re interested in using greener or sustainable alternatives while in the hospital, such as reusing their towels and selecting vegetarian menu options. But Ozelsel believes anesthetic options could also be included in the survey, especially if patients are told about the impact their choice could have on the environment.

A huge difference

And if the health-care industry fails to cut its emissions from anesthetic gases, the regulation should come from the government, Ozelsel said.

However, it’s unclear whether the government would take up the task. According to Environment and Climate Change Canada, reporting anesthetic gases isn’t required as part of the United Nations Framework Convention on Climate Change.

As for Le at Mount Sinai Hospital, he acknowledges that change does come slowly. But he believes education is the key to reducing emissions. He’s trying to teach the next generation of doctors about the impact of different anesthetic gases and how they are administered.

“A slight modification in how they practise anesthesia can make a huge difference.”