April 28, 2022

Department of Anesthesiology launches initiative to minimize the field’s impact on climate change

Project aims to reduce department’s greenhouse gas emissions from anesthetic gases by 80%.

Michigan Medicine Anesthesiology delivered anesthesia services for more than 100,000 surgical cases last year. But alongside the lifesaving and life-enhancing care patients receive comes an unwanted consequence: release of greenhouse gases and ozone-depleting agents into the atmosphere.

The Department of Anesthesiology has launched a new initiative to reduce its greenhouse gas emissions and minimize its impact on climate change. The Green Anesthesia Initiative (GAIA) aims to implement environmentally sound health care practices while continuing to protect public health and provide excellence in patient care.

Department Chair George Mashour, M.D., Ph.D., said the impact of health care on the climate has been the subject of intense discussion — but the field of anesthesiology is poised to make positive changes.

“I believe that we can, and should, be doing better as a department and as a field to be good stewards of our environment,” said Mashour, the Robert B. Sweet Professor and Chair of Anesthesiology. “Fortunately, unlike many other industries and fields, making smarter environmental choices as an anesthesiology department does not necessarily entail tectonic shifts or disruption. Rather, it requires intentionality about our anesthetic and clinical care choices — and we do have attractive options.”

Mashour and GAIA leads David Hovord, MB BChir, and Prabhat Koppera, M.D., formally introduced the initiative Thursday during a department-wide virtual town hall.

GAIA aims to reduce the department’s greenhouse gas emissions from anesthetic gases by 80% over a three-year period. Phase one, which will begin this quarter, will focus on:

  • Switching to anesthetics with a lesser carbon footprint, such as sevoflurane
  • Eliminating use of desflurane
  • Reducing use of isoflurane and N20

Administering sevoflurane for an hour has an approximate environmental impact of driving a gas vehicle 20 miles while an hour of desflurane is estimated to equate to 400 miles. 

Hovord said the GAIA planning team considered factors beyond environmental impact and patient care when determining these first steps — including provider adaptability, impact on the learner experience, and potential costs — and that he anticipates further collaboration as the initiative develops.

“How do we get from here to there? This is the million-dollar question in any kind of problem like this,” Hovord said. “We want this to be locally led — provider-focused and provider-led. We want to put the data out there and let the frontline providers be heard, be a part of the decision-making process about how we proceed forward.”

Phase two will focus on the use of low-flow practices with a goal to reduce current flows by 25%, reducing the release of anesthetic in the environment and minimizing anesthesia delivery costs. This phase will include a significant educational element for all providers to encourage the use of low-flow anesthetic care when clinically appropriate and to provide additional training as necessary to minimize patient safety risks.

Nitrous oxide has an atmospheric lifetime of 114 years. 

Phase three seeks to broaden the initiative’s impact — both within the department and beyond — as leadership further commits to reducing the amount of anesthesia waste and diverting as much as possible from landfills. Plans for this phase include:

  • Creating anesthesia site-specific workgroups to develop additional solutions in support of GAIA’s carbon emissions reduction goals
  • Developing a consortium with other health care systems to influence environmentally preferred purchasing practices

Koppera said this final phase highlights the need for collaboration in addressing one of the most pressing issues of our time. 

“This is an opportunity for us to be leaders and change advocates for the other divisions that use these agents to investigate their own use of them and then make a decision based on a very holistic approach,” Koppera said. “We can be leaders amongst our colleagues, both within anesthesia and at the local level at the university, as well as among other academic anesthesia departments across the nation.”  

Related: Operating rooms are the climate change contributor no one's talking about

GAIA’s project team includes faculty, staff, and learners from across the department’s clinical sites, as well as staff from Michigan Medicine representing pharmacy ordering, environmental sustainability and safety.

“As Michigan Medicine becomes more engaged in the University of Michigan’s commitment to pursuing more environmentally sustainable strategies, the Department of Anesthesiology is poised to be a vital contributor and leader, thanks to the GAIA team,” Mashour said. “I look forward to working with GAIA leaders, all our anesthesiology team members, and colleagues across Michigan Medicine in the coming years as we strive to do what is right for our patients and our planet.”