WHY IS IT IMPORTANT?

• All common inhaled anesthetics have

global warming potential.

• We can reduce the global warming

impact of anesthetic agents by

managing fresh gas flow and

inhalational agent choice.

• Anesthetic agents are a significant

contributor to US healthcare CO

2

emissions

SUS-02: Global Warming Footprint,

Maintenance

SUS-03: Global Warming Footprint,

Induction

• For cases using inhalational anesthesia,

ensure that desflurane has been turned off

in favor of sevoflurane or isoflurane

• CO2 absorbents are free of strong bases

(NaOH, KOH)

• The minimum fresh gas flow has been

estimated using an accredited formula or

simulation software

PRE-OPERATIVE CHECKLIST

•During intubation, leave the fresh gas flow

off/vaporizer on

•Pediatric Induction:

•Limit nitrous oxide unless medically

necessary

•Incorporate IV anesthetics

•Minimize fresh gas flow for the duration of

induction

•For a sevoflurane mask induction, use

distraction techniques such as electronic

media, conversation, and premedication

INDUCTION REMINDERS

• Minimize fresh gas flow

• Avoid nitrous oxide unless clinically

preferred

• Set the vaporizer to deliver a concentration

greater than intended

• Closely monitor O

2

, CO

2

, and anesthetic

concentrations while delivering gas at

minimum FGF

MAINTENANCE REMINDERS

SUSTAINABLE ANESTHESIA

SUSTAINABILITY MEASURES

GLOBAL WARMING FOOTPRINT

FRESH GAS FLOW

SUS-01: Fresh Gas Flow, less than or

equal to 3L/min

SUS-04: Fresh Gas Flow Less than/equal

to 2 Liters per minute

SUS-06-Peds: Low Fresh Gas Flow,

Pediatric Induction

NITROUS OXIDE AVOIDED

SUS-05-Peds: Nitrous Avoided, Induction

SUS-07: Nitrous Avoided

PRACTICE RECOMMENDATONS

Learn more about

Sustainable

Anesthesia on our

website: