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Inhaled Anesthesia Climate Initiative and Research

Inhaled anesthetics are potent greenhouse gases. Waste anesthetic gases (WAGs) are routinely vented off facility rooftops, where their emissions to the outdoor environment are currently not controlled. Several simple strategies can reduce these emissions, and serve to protect public health, without compromising patient care.

Some institutions have made great progress in reducing their inhaled anesthetic footprint, while others are just beginning. It is critical to measure the current state of emissions, and track mitigation progress. Project Drawdown aims to benchmark facility-level inhaled anesthetic carbon footprints, as well as per-case averages, to compare and inspire performance improvement efforts.

To this end, we are conducting a study through the free Yale research app, (Gassing Greener,) for the purposes of anonymous facility data pooling. By participating in this study, you will contribute to a growing body of knowledge to help leverage carbon drawdown in the healthcare sector across the globe. Participants may opt to receive a report of their carbon footprint results.

For More Details

Click here to view the American Society of Anesthesiologists Environmental Task Force document.

Anesthesiology Sustainability Checklist

Anesthesiology Sustainability Checklist

By the American Society of Anesthesiologists, Environmental Task Force.

I. Reduce Inhaled Anesthetic Atmospheric Waste

  • Utilize low fresh gas flows
  • Avoid high impact inhaled anesthetics: Desflurane, Nitrous Oxide
  • Consider intravenous and regional techniques
  • Invest in WAG trapping (for volatiles only) or WAG destroying (all inhaled anesthetics, including Nitrous Oxide) technology for the Anesthesia Machine

II. Reduce IV Pharmaceutical Waste

  • Use prefilled syringes
  • Use appropriate sized vials for an individual patient
  • Dispose of unused medications and vials according to regulations (and not exceeding)

III. Reduce Anesthesia Equipment Waste

  • Only open equipment intended for immediate use
  • Consider purchase of reusable or reprocessed equipment over disposable
  • Reprocess or recycle suitable disposable equipment
  • Adjust stock levels to minimize discarding expired items
  • Reformulate prefabricated kits to eliminate unnecessary items
  • Reformulate anesthesia supply carts to eliminate unnecessary items
  • Donate expired or unused open equipment

IV. Solid Waste Segregation

  • Segregate waste according to type (pharmaceutical, solid, biohazard, etc.)
  • Avoid default of placing all waste into a biohazard or sharps bins
  • Recycle batteries
  • Consider intraoperative recycling program for clean plastics, paper and cardboard
  • Use reusable sharps containers

V. Linens

  • Consider reusable linens
  • Minimize excessive use of reusable and disposable towels and blankets

VI. Electronics

  • Avoid excess electronics without proven benefit to patient care
  • Use a certified sustainable electronics recycling vendor to dispose of old equipment
  • When negotiating equipment upgrades/contracts, request vendors take back old equipment for refurbishment and donation, or request vendor use a certified sustainable electronics recycling vendor

VII. Leadership

  • Develop/join a Sustainability Committee at a department, hospital, or society level
  • Become involved in environmental preferable purchasing
  • Educate staff regarding the health, safety, and cost benefits of environmental projects
  • Evaluate new equipment, facility, and behavior options for improved sustainability
Select References
  • Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386(10006): 1861-914.
  • Eckelman M, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health, PLoS ONE 2016;11(6)
  • Vollmer M, Rhee T, Rigby M, Hofstetter D, Hill M, Schoenenberger F, Reimann S. Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere. Geophys Res Lett 2015 March;42(5):1606-11
  • Sherman J, Le C, Lamers V, Eckelman M. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg. 2012; May;114(5):1086-90
  • Carbon Footprint from Inhaled Anesthetic Gases, National Health Service England and Public Health England, Sustainability Development Unit,
  • Thiel C, Eckelman M, Guido R, Huddleston M, Landis A, Sherman J, Shrake S, Copley-Woods N, Bilec M.: Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States. Environ Sci Technol 2015;49:1779-1786
  • Ryan S, Nielsen C. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010 Jul;11(1):92-8
  • Feldman, JM. Managing fresh gas flow to reduce environmental contamination. Anesth Analg. 2012; May;114(5):1093-101
  • McGain F, Sussex G, O'Toole J, Story D. What makes metalware single-use? Anaesth Intensive Care 2011; 39: 972-3
  • Eckelman M, Mosher M, Gonzalez A, Sherman J: Comparative Life Cycle Assessment of Disposable and Reusable Laryngeal Mask Airways. Anesth Analg 2012; 114: 1067-1072
  • McGain F, Jarosz K, Nguyen M, Bates S, O'Shea C. Auditing Operating Room Recycling: A Management Case Report. A A Case Rep 2015 Aug 1;5(3):47-50
  • McGain F, Algie C, O’Toole J, Lim T, Mohebbi M, Story D, Leder K. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014 Apr;69(4):337-42
  • Sherman J, Ryan S. Ecological responsibility in anesthesia practice. Int Anesthesiol Clin. 2010 Summer;48(3):139-51

Get the Free Yale Gassing Greener App

Yale Gassing Greener helps anesthesia providers build environmentally conscious practices. Developed by Yale University’s Department of Anesthesiology, the app features two calculators that provide reports on carbon emissions based on clinician and facility use of inhaled anesthetics. The clinician calculator allows anesthesia providers to enter amounts and flow rates of inhaled anesthetics in a case and obtain their carbon emission equivalents. A facility calculator allows perioperative personnel to enter amounts of purchased inhaled anesthetics and receive a comprehensive emailed report of their facility’s carbon emissions. By informing practitioners about the global warming impact of their anesthetic choices, Yale Gassing Greener hopes to encourage environmental awareness in clinical practice.

Yale Gassing Greener is a free software application. The app is currently available in English and it was last updated on 2016-11-08. The program can be installed on Android or Apple IOS.

For more information, please contact:

Jodi Sherman, MD

Associate Professor of Anesthesiology, Yale School of Medicine

Associate Professor of Epidemiology (Environmental Health Sciences), Yale School of Public Health

Director of Sustainability, Anesthesia, Yale-New Haven Hospital

333 Cedar Street, TMP3

New Haven, CT 06520-8051

p. 203.785.2802

f. 203.785.6664