Anaesthetic gases are a 'carbon hotspot' for the NHS. As these gases are released on our sites, they are included in our core 'NHS Carbon Footprint'.
The gas that has the largest impact is desflurane, with an impact on the environment 2,500 times higher than that of carbon dioxide. Over recent years, our clinicians have been moving away from desflurane to alternative options that are just as effective for patients but better for the environment, where clinically appropriate. This includes using gases such as sevoflurane or total intravenous anaesthesia (i.e. via injection).
Between 2013/14 and 2022/23, we have reduced our annual consumption of desflurane by 98.4%, despite an increased number of procedures over this time.
In early 2023 NHS England, with the support of the Royal College of Anaesthetists and the Association of Anaesthetists, announced that desflurane would be decommissioned nationally by early 2024.
Another area that is particularly carbon intensive, due to the volumes consumed, is nitrous oxide. This is used as a carrier gas during surgery or as a form of painful relief, when mixed with oxygen to form Entonox ('gas and air').
Piped nitrous oxide used in operating theatres is transported via a manifold. Audits at other trusts around the country have identified leaks of nitrous oxide through the manifold supply, with over 90% waste in some cases. This obviously has financial and environmental impacts. There are also health impacts of leaks when they occur at high levels in enclosed environments.
Historically, the three main hospital sites at LUHFT have had a manifold supply of nitrous oxide. In December 2021, the manifold at Broadgreen site was decommissioned and the new Royal Hospital does not have a manifold. Work is currently ongoing to assess the effectiveness of the Aintree manifold and whether there is clinical demand to continue to operating it.
Carbon Emissions
Emissions from all anaesthetic gases have dropped by almost 63% compared to the baseline year of 2013/14. Therefore, this category is currently exceeding the Trust 50% reduction target by 2025.
As is evident from the graph below, reducing the use of nitrous oxide is the primary focus in order to continue to reduce emissions from anaesthetic gases.
