Sustainable anaesthesia
Green anaesthesia: paving the way to Net Zero
Anaesthetists are making progress in reducing their impact on the environment. Dr. Paul Southall, an Elected Council Member of the Royal College of Anaesthetists and Environmental Advisor to the College, provides an insight into how the specialty is striving to ensure the NHS meets its Net Zero ambitions.
When the NHS announced its ambition to become the first carbon Net Zero national health system by 2040, I, like many other doctors, applauded the commitment but was somewhat daunted by the scale of the task.1 Climate change and air pollution are already
having an impact on our health. According to data released by the UK Health Security Agency, in 2020 heatwaves caused more than 2,500 deaths in the UK.2
Warmer temperatures will
make the British climate more hospitable to mosquito based diseases, such as dengue and West Nile virus.3
The Mayor of London’s office
released research from Imperial College London that found, in 2019, toxic air contributed to the premature death of approximately 4,000 people and, in a global first in 2020, the death of a 9-year-old girl from South London was ruled by a coroner to be a direct result of air pollution.4 Clearly, climate change is a real and present
danger to public health, which is why reducing our carbon emissions must be taken as an essential part of NHS services.
Anaesthesia’s environmental impact According to its 2020 report, Delivering a ‘Net Zero’ National Health Service, the NHS is responsible for around 4% of the nation’s carbon emissions. Of this, an estimated 2% comes from anaesthetic gases and 3% from inhalers. While advances in scientific understanding of climate change and radiative forcing mean that the 2% figure is likely to be an overestimation, the NHS Long Term Plan commitment to lowering carbon emissions from anaesthetic and analgesic
practices by 40% is a laudable one, and one which the specialty continues to tackle head on.5 As an anaesthetist, this felt very much like an opportunity, and four years on, while the target remains ambitious, we are making demonstrable progress.
Pipeline nitrous oxide The anaesthetic output of carbon dioxide equivalence is brought on from two types of inhalational gases: volatile agents (desflurane, sevoflurane, etc.) and nitrous oxide.6
Nitrous
oxide accounts for the vast majority of ’direct’ anaesthetic emissions and has multiple uses as both an anaesthetic and analgesic agent. In an operating theatre, nitrous oxide is usually supplied by a manifold of cylinders to enable a continuous supply. Outside the theatre, nitrous oxide is often used in a gas mixture of 50% oxygen and 50% nitrous oxide, known as Entonox,
Through steps like decommissioning pipeline nitrous oxide and favouring point-of-use cylinders, the NHS is demonstrating that high-quality patient care and environmental responsibility can go hand in hand.
Decommissioning leaky manifolds An investigation by Alifia Chakera at NHS Lothian found that a significant portion of nitrous oxide used in the operating room was being wasted by leaks in the manifold that delivered the drug to theatre.7
In fact, 83-100% of nitrous oxide was
leaking out into the atmosphere before reaching the point of delivery. This leak represented not only a large amount of carbon emissions but also a waste of hospital funding. Once this information about the prevalence of leaks was widely circulated, areas of previous high use began to move away from routine nitrous oxide use, such as paediatric anaesthesia and general anaesthesia in obstetrics, having a dual benefit of reducing waste and saving
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‘laughing gas’ or ‘gas and air’. Nitrous oxide is an abundant, long-lived
greenhouse gas with an atmospheric lifetime of over 100 years and a carbon dioxide equivalence of 298 (that means 1kg of nitrous oxide has the same warming effect on the climate as 298kg of carbon dioxide). This long atmospheric lifetime and the fact it comprises such a significant proportion of emissions, means reducing nitrous oxide use would go a long way to reducing anaesthetic emissions.
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