An international initiative to tackle this issue, called Project SPRUCE (Saving the Planet by RedUcing Carbon Emissions), is gaining momentum. The project is a collaborative effort among pediatric hospitals to lower greenhouse gas emissions from anesthetic gases, focusing on inhaled anesthetics and N2O. With advanced software that pulls data from electronic medical records, the project team can measure how much these gases are used and calculate the equivalent carbon emissions (CO2e) they create.
The project’s goal is ambitious: a 50 per cent reduction in anesthesia-related greenhouse gas emissions within one year.
Progress at BC Children’s Hospital
The team at BC Children’s Hospital (BCCH) joined Project SPRUCE in early 2024, collecting four months of baseline data. They found that their average CO2 emissions rate from surgical procedures was already exceptionally low—0.02 kg CO2e per minute of anesthesia— more than ten times lower than other hospitals participating in the project. This is mainly because they often use total intravenous anesthesia with Propofol infusions instead of inhaled gases. However, N2O was used in 14.3 per cent of cases, with an average volume of 1.73 litres per case.
We were pleasantly surprised to already have such a low baseline compared to other hospitals,” said Dr. Stephan Malherbe, pediatric anesthesiologist at BCCH and project lead. “While good news, it does make meeting our target of a 50 per cent reduction more challenging so we’re grateful to have the department so receptive.”
In April, the BCCH team held a department-wide teaching session on using “low flow” anesthetic techniques, emphasizing the benefits of reducing fresh gas flows (FGF) and minimizing N2O use. When they reviewed the next four months of data, they found some positive trends: N2O use dropped to 7.9 per cent of cases, and the average volume of N2O per case halved, from 1.73 to 0.85 litres. Although the CO2 emissions per minute didn’t show a big change, reducing N2O use is a strong start toward sustainability goals.
Next steps to a lower carbon footprint
Because the BCCH team’s starting CO2 emissions are already low, reaching the 50 per cent reduction goal will take a team effort. But they are planning several new steps to get there. First, they are aiming to reduce the default FGF setting on all anesthesia machines from 500ml/min to 300ml/min. Additionally, they are working with C&W Intercampus Operations, BC Women’s Hospital, and the BC Children’s PainCare 360 teams to explore the possibility of phasing out the hospital’s central N2O pipeline supply and using N2O from canisters, which better contain the gas and minimize leaks.
With continued efforts, BCCH can make a real impact in reducing greenhouse gas emissions from anesthetic gases. When everyone contributes toward a common goal, we can make meaningful progress toward a healthier planet for future generations.
