Q&A: Anesthesia’s Effect on Surgery’s Carbon Footprint

Q&A with Rachel Outterson, MD, on the healthcare industry’s responsibility to provide more sustainable care.

How does the administration of anesthesia add to the carbon footprint of surgical care?
The delivery of anesthesia care involves many single-use plastic items, vials of medications and kilowatts of electricity. Plus, it has a uniquely heavy carbon footprint because of the delivery of anesthetic gases. Every anesthetic gas is a potent greenhouse gas with a global warming potential (GWP) order of magnitude higher than that of carbon dioxide. Under general anesthesia, a patient breathes out the anesthetic gas after administration, and it is taken up by a scavenging system on the anesthesia machine and released from the roof of the building directly into the atmosphere where it will continue to exist for many years. Because of this, anesthetic gas alone can account for 50% of the lifecycle greenhouse gas emissions of an entire surgery.

What is the Health Sector Climate Pledge and why is it important?
The Health Sector Climate Pledge, which was first proposed in 2022 by the U.S. Department of Health and Human Services, is a commitment by healthcare organizations to: “At minimum, reduce organizational emissions by 50% by 2030 (from a baseline no earlier than 2008) and achieve net-zero by 2050, publicly accounting for progress on this goal every year; designate an executive-level lead for their work on reducing emissions by 2023 and conduct an inventory of Scope 3 (supply chain) emissions by the end of 2024; and develop and release a climate resilience plan for continuous operations by the end of 2023, anticipating the needs of groups in their community that experience disproportionate risk of climate-related harm.”

The Pledge, which currently has 116 healthcare organizations representing 872 hospitals as signatories, goes a step beyond simply recognizing the risk of climate change to human health. It acknowledges that we in the healthcare industry contribute to the problem with our current unsustainable practices, asserts that we have a responsibility to provide health care more sustainably, in a way that cares for our patients without causing harm to public health, and lays out a timeline and framework for doing so.

How does regional anesthesia lower a facility’s carbon footprint?
Regional anesthesia can be the primary anesthetic for surgeries that would otherwise require a general anesthetic — and all attendant carbon costs associated with that approach. In cases where regional anesthesia allows for minimal or no sedation and minimal or no supplemental oxygen, the carbon cost is further decreased. Even when a regional anesthetic can’t serve as the primary anesthetic, its use can still decrease the medications required for sedation, intraoperative and postoperative pain management. Regional anesthesia can also decrease some postoperative complications, the management of which come with their own carbon costs. OSM