Abstract
BACKGROUND: Due to their chemical nature as fluorinated hydrocarbon compounds, volatile anesthetics are highly potent greenhouse gases, with desflurane having by far the largest CO 2 -equivalent (CO 2 e) footprint. In everyday clinical practice, the CO 2 e footprint can easily be reduced through the increased use of propofol or sevoflurane as well as low- and minimal-flow techniques or through the more frequent use of regional anesthesia techniques. We wanted to assess to what extent educational measures on sustainability aspects of the use of volatile anesthetics had an impact on daily practice in anesthesiology departments and to what extent this influenced the hospital's CO 2 e emissions. METHODS: We conducted an observational data analysis of the consumption of anesthetics (sevoflurane, desflurane, isoflurane, and propofol) at all 3 clinical Charité campuses in the period from 2015 to 2023. The CO 2 e emissions were calculated for sevoflurane, desflurane, and isoflurane. External and internal (top-down or bottom-up) educational measures focusing on sustainability in anesthesia took place from September 2018 on. Shifts in CO 2 e emissions related to the educational measures are shown in a run chart. The number of surgeries, surgery duration, and purchasing costs were included in the analysis. RESULTS: CO 2 e emissions of volatile anesthetics were reduced by 90.3% from the baseline epoch (years 2015-2017) before educational interventions took place to 2023: CO 2 e 1470 tons (mean 2015-2017), to 191 tons (2022) to 142 tons (2023). This change was brought about by the phasing out of desflurane and the use of propofol or sevoflurane and regional anesthesia where appropriate. The fastest and most sustainable changes were seen after internal top-down measures. The total cost of anesthetics also fell over the period under review (from €541,102/$594,238 in 2015 to €281,646/$309,303 in 2023). CONCLUSIONS: Educational measures for anesthesiologists about the climate-damaging effects of volatile anesthetics-especially desflurane-can significantly reduce CO 2 e emissions in anesthesia clinics. On the positive side, these measures have also reduced the annual costs for anesthetics.