Canada’s health system reports about five percent of the country’s greenhouse gas emissionsbut anesthesiologists at the Royal Columbian Hospital in Vancouver Metro are moving to limit the carbon footprint of their surgical ward.
Patients who are under the knife in RCH will no longer be put to sleep with desflurane, a highly pollutant that RCH anesthesiologists say has 25 times more greenhouse gas emissions than its alternative, sevoflurane.
The hospital will also return to the manufacturers of evaporators used to administer gas.
Eagle Ridge Hospital, a smaller emergency facility in nearby Port Moody, will also ban anesthesia.
Dr. Cedric Ho, an anesthesiologist at Royal Columbian and Eagle Ridge Hospitals, acknowledges that both desflurane and sevoflurane have the potential for global warming, but the differences between their effects on climate are significant.
“If I gave you the anesthetic (desflurane) for two hours, it would be the same as you and I getting into an SUV and going to Kamloops (a 350-kilometer drive),” Ho said. “While the other option is like a short trip, only locally.”
Studies show treatment of patients with desflurane there are no significant advantages over other alternatives. Ho refers to individual preferences among anesthesiologists.
“That’s exactly how we can all have a different brand that we like for a diet car, but really, in many ways, it doesn’t make much of a difference.”
Royal Columbian Hospital follows a handful of surgical wards across the country that have stopped using desflurane, including Health Sciences North (HSN) in Sudbury, Ont.
Dr Sanjiv Matur, a doctor at HSN, said the hospital had managed to eliminate 700 tonnes of carbon dioxide a year after switching entirely to sevoflurane.
“[It’s] the equivalent of getting in a car at 28 miles per gallon, driving four times to the moon and back, “Matur said.
Mathur is a co-author a report examining the impact of anesthetic gases on climate and attributes these preferences to marketing.
“It was marketed as faster to wake patients up, so the reality was that it was never achieved in more rigorous research,” Matur said.
Matur said there were no differences in patient outcome and recovery after switching to sevoflurane.
Dr. Sanjiv Matur is an anesthesiologist at Health Sciences North. (Casey Strange / CBC)
Ho also points out that more than 95 percent of anesthetic gases are not metabolized by the body.
“Everything we give to the patient eventually comes back,” Ho said. “But they are actually allowed to rise essentially like a chimney up into the atmosphere from the top of the hospital.”
Ho admits that there are solutions for capturing, cleaning and recycling desflurane, but insists that the best solution is not to use it at all.
Dr Kai Chan, a professor at UBC and research chair at the Institute for Resources, Environment and Sustainability, said moving away from operating rooms from desflurane was a small but important step.
“It has been known for more than a decade that desflurane has a really strong impact on greenhouse gases and it has taken a long time for some hospitals to change,” Chan said.
The growing movement of health care providers caring for climate change “
Matur said he was working with the Citizens Climate Lobby to ban desflurane, possibly through carbon pricing. He has done research on how legislation can work to phase out the drug.
“I have published a document showing that if you apply the current carbon pricing mechanism in Canada to these (gas) agents, desflurane will no longer be competitive and hospitals will probably simply not buy it.”
He says he wants Canada to be the first country to ban desflurane and to follow the UK’s NHS system’s national efforts to reduce the country’s health footprint.
Mathur’s research on the climate impacts of anesthetic gases began when the Canadian Medical Association and other medical publications called on physicians to look for ways to minimize the carbon footprint of healthcare.
“Once I realized that this was a threat to my children’s future, I began to explore what we could really do,” Matur said. “I was shocked to learn that the gases used every day – desflurane and sevoflurane – are actually agents with a very high carbon footprint.”
According to Chan, RCH moving away from desflurane represents “a growing movement of health care providers looking for climate impacts. He called for a framework that included climate considerations in health operations.
“If all industries were responsible for all major greenhouse gases, then that would be something that would already be taken into account,” Chan said.
Ho says it would be difficult to ban a substance that is still considered effective and safe, but hopes the ban on RCH for desflurane will spread to other hospitals.
“We hope that other groups will consider this decision and say, ‘Well, it was simple.’
With files from Belle Puri
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