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Friday 5 November 2021

The Theatre department and wider teams at Worcestershire Acute Hospitals NHS Trust have been working together to tackle climate change by using alternative anaesthetic gases to lessen their environmental impact.  

Across the NHS, anaesthetic gases are commonly used as a part of everyday surgeries, when putting patients to sleep and managing pain. These gases alone are responsible for over two per cent of all NHS emissions. 

Consultant Anaesthetist Dr Paul Southall and colleagues have been using alternative surgical anaesthesia options to reduce the use of one type of anaesthetic gas in particular – desflurane – which is one of the most harmful for our environment. Their work means desflurane made up just 4.8 per cent of anaesthetic gases used at Worcestershire’s hospitals in the last 12 months, down from to 30% in 2014/15 – the biggest decrease amongst hospital trust’s in the West Midlands, and one of the top performers compared to hospital Trust’s nationally. This is also well below the target of less than 10% set nationally by NHS England

Dr Southall, who recently attended the Greener NHS regional roadshow as a guest speaker, to share best practice, said: “Desflurane has 20 times the environmental impact of other anaesthetic gases, and using a bottle has the same global warming effect as burning 440 kg of coal.

“Caring for our planet, is caring for our patients. Our aim is always to provide excellent patient care, and why not do that whilst also caring for our environment?

“The reduction is our use of desflurane is a huge achievement from all those who work in our theatre departments across our hospitals. Simply by substituting desflurane for other anaesthetic gases, which are just as safe and effective we’ve managed to reduce our use of desflurane substantially 

“Compared to our usage back in 2014/15 we have seen an incredible reduction, which equates to a reduction of well over a million car miles within the last seven years.”

“Our aim is to reduce this further to less than 2% ,and then eventually to zero, through continued teaching and early adaptation of new technologies”

The anaesthetic team are also exploring other methods to reduce their carbon footprint when using medical gases for surgical procedures.

Anaesthetics is the only speciality that uses pipelined pure nitrous oxide, and its use in modern practice is largely limited to emergency Caesarean sections and paediatric anaesthesia

Discussions are currently underway to find out the cost of modifying anaesthetic machines so that nitrous oxide can be used in cylinder form rather than a pipeline supply. This would allow the use of nitrous oxide where clinically indicated, but decommissioning of the pipeline supply, reducing costs, both with the carbon footprint and financially with current wastage.

Work is also under way looking at gas capture technology. The involves units that absorb all of the anaesthetic vapours used before they are vented to the atmosphere. Significantly, these units can then redistill these vapours to be reused, and would reduce the overall environmental impact of all the anaesthetic vapours used in the trust to near zero

Among these plans to help reduce the carbon footprint with the theatre department, other initiatives are being worked on across the Trust to help protect our planet including, reducing the use of single-use plastic cups, rewriting countywide asthma guidelines to encourage prescription of Dry Powder inhalers opposed to commonly used inhalers which use propellants in the inhaler that have a significant impact on the environment.

On the recent sustainability developments Dr Julian Berlet, Divisional Director for Specialised Clinical Services at Worcestershire Acute Hospitals NHS Trust, added: “Everyone has a part to play to help us reduce our carbon footprint. Any initiative no matter what the size can have a significant impact on improving patient care, whilst delivering sustainable healthcare for our communities.”