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Spotlight on Sustainable Healthcare

Reducing Emissions Related to Anesthetics Gases

Beth Israel Deaconess Medical Center (BIDMC) in Boston successfully reduced anesthetic gas emissions by approximately 90 percent since 2016 through strategic measures, including forming a Greening the OR Working Group, removing desflurane from their formulary, promoting low-flow practices, and transitioning from H-cylinders to compressed gas to e-cylinders. The removal of desflurane, initially implemented on a "upon request" basis and later fully banned for general anesthesia after a comparative study showed no reduced risk, contributed significantly to the environmental impact. BIDMC's success highlights the feasibility of impactful environmental initiatives managed by a single department without compromising patient care quality.

Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center (BIDMC) is an academic medical center located in the heart of the Longwood Medical Area (LMA) in Boston.

BIDMC is part of Beth Israel Lahey Health and is a teaching affiliate of Harvard Medical School. They are a health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, and more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.

BIDMC’s passion is caring for their patients like they are family, discovering new therapies and cures using the most advanced technologies, and inspiring and teaching the caregivers and investigators of tomorrow. They believe in putting people at the center of everything they do to provide extraordinary care every day.

Taking Action

BIDMC reduced emissions related to anesthetic gases by implementing the following strategies:

  • Established a Greening the OR Working Group with Anesthesia representation
  • Removed desflurane from the organization’s formulary
  • Educated staff on low flows
  • Transitioned from H-cylinders to compressed gas to e-cylinders

Desflurane was gradually removed from the operating rooms through a “upon request” system, followed by a complete ban of desflurane for general anesthesia.

This removal was conducted after a comparison study1 of the post-operative respiratory complications between desflurane and sevoflurane whereby no reduced risk was found for the use of desflurane.

5105000+

kg CO2 (equivalent)

reduced anesthetic gas greenhouse gas emission since 2016

Impact & Lessons Learned

Given that these strategies are primarily managed by a single department, they are some of the easiest to implement to have a significant environmental impact while not impacting the quality of patient care. Another lesson learned regarding the transition from central to local storage of nitrous oxide was that there should be capital budget available to decommission the piping system in order to ensure the intended impact.

BIDMC’s Environmental Sustainability Committee, alongside their Jane Matlaw Environmental Champion awardees. For 25 years, they’ve hosted an annual sustainability celebration that offers the opportunity to reflect and celebrate how far they have come to create a healthy future for their patients, their families, and themselves through their sustainability efforts at BIDMC. At this event, they honor individuals and teams that have demonstrated leadership and innovation towards their sustainability goals.

BIDMC’s Environmental Sustainability Committee, alongside their Jane Matlaw Environmental Champion awardees
  1. Zucco L, Santer P, Levy N, Hammer M, Grabitz SD, Nabel S, Ramachandran SK. A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single-centre cohort study. Anaesthesia. 2021 Jan;76(1):36-44. doi: 10.1111/anae.15203. Epub 2020 Aug 3.

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