Sustainable anaesthesia
money. It is important, when possible, to work with our operational leaders within Trusts to find and implement environmental solutions. Often sustainability goes hand in hand with financial considerations, if not in up-front costs, then in savings on the back end. When we recognise the need to work together, we can find and implement solutions all the faster. In this sense, our relationship is symbiotic, and decommissioning nitrous oxide manifolds is a good example of that. Clinical leads couldn’t make the arrangements to decommission leaky manifolds on their own, and equally, facilities departments need clinical backing before changing anything that affects patient care.
An anaesthetic consensus Earlier this year, a consensus statement led by the Royal College of Anaesthetists, in partnership with the other leading anaesthetic organisations in the UK and Ireland, recommended that Trusts and Health Boards decommission their nitrous oxide manifolds as soon as possible. This was on the basis that pipeline nitrous oxide need no longer be considered an essential drug in modern anaesthetic practice, and that continuous supply of nitrous oxide to theatre sites via a pipeline supply is no longer essential.8 We hope the transition from nitrous oxide manifolds will be completed by the end of the 2026/27 financial year in the UK and Ireland. It’s important to emphasise that this
recommendation is about the means of supply of pure nitrous oxide. Nitrous oxide will remain widely available for use in circumstances where it is beneficial to patient care, but this should be via point-of-use cylinders. With that in mind, the consensus statement also advises that Trusts and health boards should liaise with their supplier of nitrous oxide to ensure the increased demand for point-of-use cylinders can be met and maintained. It also makes clear that the recommendation doesn’t apply to pipelined Entonox for us in non-theatre areas
such as the delivery suite. In short, the work undertaken on nitrous oxide – like all action to reduce anaesthetic gas emissions – is not ’all or nothing’. Any reduction in emissions is helpful, but patient benefit must always be prioritised.
Change is possible: desflurane The progress made with decommissioning nitrous oxide manifolds builds on the sustained action to reduce the use of another anaesthetic gas, desflurane, which was decommissioned earlier this year. After the potential negative environmental impacts of desflurane became known, the specialty started to reduce our use of the drug. Over the course of just three years, from 2021 to 2024, anaesthetists decreased the proportional use of desflurane from 10% down to 2%. What we found during that time is that the use of desflurane was largely optional from a choice of drugs. After identifying the potential large environmental impact, it was in many cases as simple as just choosing an alternative agent for general anaesthesia. Following this sustained reduction in usage, desflurane was officially decommissioned in
April 2024. While there are exceptional clinical circumstances when it might be in the best interests of patients to use desflurane (and we need to keep evidence under review), this shows that change is possible.
More efficient patient care is more sustainable patient care While changes within anaesthetic practice are helping us reduce emissions from anaesthetic gases, there are also more systemic factors at play. We need to think of sustainability as part of the wider imperative to reduce waiting lists and take a more preventative approach. For example, long waiting lists mean that by the time some patients have surgery, their operations are longer and more complex. They might be more likely to need general rather than local anaesthetic, which increases the overall carbon footprint of their surgery. So, reducing waiting lists and ensuring more efficient and timely care for patients can have sustainability benefits too.
The path to Net Zero The NHS’s commitment to Net Zero represents a bold and necessary response to the climate crisis. Anaesthesia, with its previous reliance on high-impact gases, is an area where sustainable practices can make a substantial difference. 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. Additionally, many sustainability initiatives also save Trusts and health boards money. Ultimately, the move towards Net Zero is about
more than just reducing emissions. It’s about building a healthcare system that keeps patient benefit and safety at its heart, while embedding
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www.clinicalservicesjournal.com I December 2024
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