Sustainability: Environmentally-friendly anesthesia

The Department of Anesthesiology at Uniklinikum Erlangen has developed a strategy for improving sustainability.

The downside of maximum-care hospitals is their climate impact: Hospitals all over the world have very large CO2 footprints. Anesthetic gases in particular are a factor that causes a significant proportion of emissions in hospitals. This is something an interprofessional team at the Department of Anesthesiology (director: Prof. Dr. Roland C. E. Francis) at Uniklinikum Erlangen wants to change. In 2024, it developed a strategy concept to enhance sustainability that has been successively implemented since then.

“Our Department and therefore all of Uniklinikum stopped using the anesthetic gas desflurane, which is harmful to the environment, some months ago. Alternative anesthetic gases, such as sevoflurane, are only used in exceptional cases,” explains Prof. Francis. “We now use propofol, which is an intravenous anesthetic. In addition to its improved ecological footprint, it also increases patient comfort.” Other strategic approaches for climate-friendly anesthesia include reducing energy consumption and using fewer single-use products. “The safety of our patients continues to be of utmost importance to us,” emphasizes Dr. Christopher Schmitt, senior physician at the Department of Anesthesiology. “This is why we involved all our staff in our sustainability concept and provided comprehensive training for the new processes. Our strategy concept involves all professions at the clinic on an equal level.”

“The use of desflurane for anesthesia for one hour generates emissions equivalent to those generated while driving from Erlangen to Flensburg,” says Dr. Schmitt when describing the damage to the environment caused by the gas. “Simply switching to sevoflurane reduces the emissions significantly, so they are equivalent to a car journey from Erlangen to Nuremberg.” In addition, not using desflurane means that the vaporizers it requires that consume large amounts of energy are also no longer needed. And, “if we use sevoflurane as an alternative, we use defined settings to reduce the amount of fresh gas required in the rebreathing system. This means less anesthetic gas is required,” explains Dr. Axel Scholler, senior physician in anesthesiology. Sevoflurane also has a long life in the atmosphere of around 1.4 years. While this is significantly shorter than that of desflurane (14.1 years), it still contributes to global warming.

Not using anesthetic gases cuts energy consumption

Another positive factor is that the limited use of anesthetic gases greatly reduces energy consumption in the operating room, because less medical compressed air is required, explains Dr. Scholler. “Each connected anesthetic gas scavenging system uses large amounts of energy, irrespective of whether the anesthesia device is running or not.” This is why the Department of Anesthesiology at Uniklinikum Erlangen only uses inhaled anesthetics such as sevoflurane, if it offers advantages for patients or for the surgery being performed. “Total intravenous anesthesia, or TIVA, using propofol is used as standard for anesthesiology and anesthetic gas scavenging systems are only set up if sevoflurane is being used,” explains Dr. Scholler. “In addition to the ecological benefits, anesthesia using TIVA is well tolerated by our patients and helps them to wake up comfortably.”

Next steps: Recycling and preventing waste

After successfully reducing the amount of harmful anesthetic gases it uses, the team at Uniklinikum Erlangen is now tackling the next items on its strategy concept for more sustainability: “This includes recycling instruments used in the OR such as the staplers used to close wounds and systematically preventing waste by switching from single-use to multiple-use items,” says Sandra Bischoff. She works as a surgical nurse and is also a member of the sustainability team at the Department of Anesthesiology. “All professions involved also work together to ensure that the new processes are implemented on a permanent basis.”

Further information:

Dr. Christopher Schmitt
Department of Anesthesiology at Uniklinikum Erlangen
Phone: + 49 9131 85 33677
christopher.schmitt@uk-erlangen.de