April 24, 2023

Green Anesthesia Initiative quickly shows progress

Michigan Medicine’s Department of Anesthesiology launched a new initiative to reduce greenhouse gas emissions and minimize its impact on climate change in 2022, and initial results have become available.

As background, anesthesiology is a carbon-intensive specialty, including the recurring use of inhaled agents which can lead to significant greenhouse gas emissions and global warming over an extended period.

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.

Every year, the department delivers anesthesia services to more than 100,000 patients on average. The drawback to these crucial services is the release of greenhouse gases and ozone-depleting agents into the atmosphere. Thanks to the GAIA, these harmful materials are being reduced, thus leaving a smaller carbon footprint.

Department Chair George Mashour, M.D., Ph.D., and GAIA leads David Hovord, MB BChir, and Prabhat Koppera, M.D., formally introduced the initiative in April 2022 during a department-wide virtual town hall.

The aims of GAIA are to reduce the department’s greenhouse gas emissions from anesthetic gases by 80% over a three-year period. Phase one, which began in spring 2022, focused on:

  • Switching to anesthetics with a lesser carbon footprint, such as sevoflurane
  • Eliminating use of desflurane, the inhaled ether with the worst carbon footprint
  • Reducing use of isoflurane
  • Reducing use of nitrous oxide

The immediate effects are already seen in a short time. The use of sevoflurane, the ether with the best environmental profile, is up 30%, isoflurane use is down 18%, and desflurane has been eliminated with the help of Michigan Medicine Department of Pharmacy.

Furthermore, nitrous oxide use has dropped by 72% across all sites. Collectively, the total carbon dioxide equivalents emitted due to anesthesia gas use is down significantly from previous years. As recently as fiscal year 2019 1.9 million CO2 equivalents were used. In the first half of FY2023, just 317.6 thousand were emitted, on pace for 635.2 thousand, a 67% decrease in four years’ time.

“We are proud to have the GAIA team lead this vital work,” Mashour said. “The Department of Anesthesiology is an enthusiastic partner with Michigan Medicine and the University of Michigan to pursuing more environmentally sustainable goals and implementing productive programs to minimize carbon footprint. Thank you to all our anesthesiology team members, GAIA leaders and fellow colleagues across the organization in helping us reach our goals and do what is best for our patients and our planet.”

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 includes a four-year plan to replace all anesthesia machines with new machines that have technology to safely automate lower gas flows.

Additionally in phase two, the GAIA project team will explore the feasibility of minimizing and/or eliminating the use of bulk N2O in the building pipelines in favor of more efficient cylinder usage.

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

“I am also proud of the anesthesia team and their focused efforts to decarbonize healthcare without compromising quality or service to our patients, said Tony Denton, senior vice president and chief environmental, social and governance officer at Michigan Medicine. “The team is actively demonstrating collaboration and creativity in finding solutions to improve planetary health.”

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.