An environmental evaluation of volatile gas use at the Royal Bolton Hospital in March 2022

Background: The fifth largest contributors of greenhouse gases (GHGs) worldwide are healthcare systems.1 In 2015, the National Health Service (NHS) contributed ∼4.6% national GHGs.2 NHS sustainable team has labelled anaesthetic volatile (GHG) as a ‘carbon hotspot’.3 Long Term Plan is to reduce 40% emissions from agents.4 global warming potential (GWP100) desflurane almost 20 times more than that sevoflurane.5 A rapid transition in practice vital. Desflurane should be discontinued and lower flow rates sevoflurane must used rates, carbon dioxide (CO2) equivalence gas.1 Methods: aim this report evaluate gas use machines at Royal Bolton Hospital (RBH) over an average 4-week period. Raw data Drager Perseus A500 Anaesthetic were collected across 13 operating theatres. questionnaire regarding was created disseminated RBH department. Results: Some 86.9% cases (84.2% sevoflurane, 2.2% desflurane). duration surgery fresh affect efficiency uptake gas. There barriers using total i.v. anaesthesia including lack availability equipment training. Figure 2 shows vs lowest flow. Conclusion: department shown encouraging reduction usage. After choice agent, low essential for practice, possible flows allow CO2 emissions. can further improvements with increase non-volatile delivery. 1Van Norman GA, Jackson S. Curr Opin Anaesthesiol 2020; 33: 577–832United Kingdom Statistics. 2015 UK Greenhouse Gas Emissions, Final Figures. Department Business, Energy Industrial Strategy. [Internet] 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/604350/2015_Final_Emissions_statistics.pdf (accessed 20/03/23)3Shelton CL, Sutton R, White SM. Br J Anaesth 125: 852–64NHS England. Delivering ‘Net Zero’NHS. London: 2020: 5–33 https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2020/10/delivering-a-net-zero-national-health-service.pdf 20/03/23)5Anderson MPS, Nielsen OJ, Wallington TJ, Karpichev B, Sander SP. Anesth Analg 2012; 114: 1081–5