Intersection of Anesthesia
and Climate Crisis
Elizabeth Hansen MD PhD
Seattle Children’s Hospital
University of Washington
Global healthcare sector's carbon footprint in 2014
2
gigatons
CO
2
equivalents
4.4% of global emissions
emissions by region
Canada
4-6% of national
emissions
United States
8% of national
emissions
https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf
Types of
emissions
Seattle
Children’s Main
Hospital
2018 emissions
Cost $265,960
Anesthetic Agents
Approximately 5% of
delivered anesthetic
metabolized
by patient
• Rest is vented to
atmosphere
• Not scavenged
(technology in
development)
Global Impact: The Environmental Effects of Anesthetic Drugs
Nathan, Naveen
Anesthesia & Analgesia133(4):825, October 2021.
doi: 10.1213/ANE.0000000000005729
1 bottle of desflurane - equivalent to 988 pounds of coal burned
Materials
People
Processes
Equipment
CAUSESPROBLEM
High Green House
Gas (GHG) Emissions
Limited GHG
education
Disposable
healthcare
culture
No GHG
awareness
High default
machine
fresh gas flow
Poor access
to EMR data
Use of
Nitrous Oxide
Use of
Desflurane
Lack of standards
for gas use
Inhalation induction
commonly used
Short case
duration increases
use of gas
What’s Known:
We Can Reduce Impact
• Eliminate Desflurane
• Eliminate or drastically reduce use of nitrous
oxide
• Reduce fresh gas flows during induction and
maintenance (decision support alerts)
• Utilize total IV anesthesia - TIVA
• IV inductions when clinically feasible
• Provide near real-time feedback on emissions
Main hospital Emissions
Emissions decreasing over time, by anesthesiologist
High emissions cases trending down
Reduction of emissions for all case lengths
Emissions at the ASC
165
183
356
568
569
Measured
Purchased
Where is the nitrous oxide going?
Non-OR uses
Dental clinic
Mobile Sedation team
Emergency Department
Cardiac ablations/Cath lab
Leaks
At central supply
Connections at pipes
Thank you!
Anesthesia group
• Ting Zha
• Kimberly Righter-Foss
• Jen Chiem
• Dan Low
• Lynn Martin
Informatics
• Amber Yun
• AdaptX team
Surgical Colleagues
• Sarah Greenberg
• Hannah Cockrell
Sustainability
• Mike Bigelow
• Colleen Groll
Email: elizabeth.hansen@seattlechildrens.org
SPRUCE Forest
