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Universitätsmedizin Berlin has reduced the annual CO 2 emissions originating from gases used for anesthesia by over 80% since 2018. This reduction in carbon emissions was achieved by using climate-friendly anesthetics in the operating room. As a study published in the journal Anesthesia & Analgesia demonstrates, education—and in particular, fundamental decisions—were the keys to success.
Gaseous anesthetics have a climate impact in that they heat the atmosphere much like carbon dioxide (CO 2 ). However, their effect is much stronger: A single kilogram of desflurane, for example, contributes almost 8,000 times as much to the greenhouse effect over a five-year period as the same amount of CO 2 . The emissions from a seven-hour operation in which desflurane is used as an anesthetic are equivalent to those from driving a car almost 7,850 kilometers.
That's about the distance from Berlin to Ulaanbaatar, Mongolia. This makes desflurane by far the worst offender among anesthetic gases in terms of climate impact. Action starting in 2018 "Most anesthesiologists don't know about the climate impact of inhaled anesthetics because it isn't part of their standard training," explains Dr.
Susanne Koch, a lecturer and anesthesiologist at Charité and the leader of the study. A member of the European Society of Anaesthesiology and Intensive Care (ESAIC) Sustainability Committee, Koch is committed to improving sustainability in anesthesiology, including at Charité. "To change that, we introduced regular informational events and continuing and professional education activities in 2018.
" The heads of the anesthesiology departments also revised the guidelines for administering anesthesia, and desflurane was eliminated Charité-wide as of late 2023. Instead, the departments are increasingly relying on local anesthesia and using propofol, an anesthetic that is given intravenously, so it has much less impact on the climate than inhaled anesthetics. For cases where anesthetic gases are necessary for medical reasons, sevoflurane is used in what is known as the "minimal flow" method, meaning there is little flow of gas.
Sevoflurane's greenhouse gas impact is less than a third of that of desflurane. Lower emissions, lower costs, no drawbacks for patients "These actions have allowed Charité to reduce anesthesia-related carbon emissions from over 7,500 metric tons per year before 2018 to 1,454 in 2023. That's more than 80%," says Astrid Lurati, Chief Financial and Infrastructure Officer of Charité.
"This works out to savings of about 6,000 metric tons of carbon dioxide a year, about the same as the emissions from 300 households in Germany. And because desflurane is also one of the most expensive inhaled anesthetics, our annual costs for anesthetic agents also fell by nearly half between 2015 and 2023." There are no medical drawbacks associated with the switch for patients—quite the opposite.
"Patients wake up calmer after anesthesia with propofol, and nausea is less common," Koch notes. "Desflurane makes it possible to control the duration and depth of anesthesia very effectively, which is why anesthesiologists like to use it. But highly effective anesthetic control is also possible when propofol is used, thanks to EEG-based monitoring, which is when brain activity is used for guidance.
" The biggest impact: Management decisions In their study, Koch and her team of researchers investigated which measures have the biggest impact on CO 2 emissions from anesthetics. They found that publications, continuing and professional education activities, and informational events—both internally within Charité and at specialized conferences—brought continuous reductions in emissions. "But the fastest and most lasting effect came from adjustments to the centralized, standard rules that all anesthesiologists are required to follow in their work," Koch says.
"This shows how important these kinds of fundamental decisions supported by the management level are." More information: Arne Schwiethal et al, The Power of Education to Reduce the Carbon Footprint of Volatile Anesthetics in Clinical Practice, Anesthesia & Analgesia (2025). DOI: 10.
1213/ANE.0000000000007375.
