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Clearing the Air

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VGH anesthesiologists innovate for a healthier planet

The Vancouver Coastal Health (VCH) Department of Anesthesia is leading the way with its environmental initiatives. After receiving funding from the Vancouver Physician Staff Association through their Small Steps, Big Ideas grant in 2022, a committee of sustainability-minded clinicians was formed to look at opportunities to reduce their environmental footprint without compromising patient care.

So far, the committee has successfully completed three projects. Firstly, they eliminated the use of the anesthetic gas desflurane at Vancouver General Hospital (VGH). Desflurane has a global warming impact potential 2,500 times greater than carbon dioxide and up to 26 times worse than other inhaled anesthetic gases. For context, using one 250-millilitre bottle of desflurane is equivalent to burning 440 kilograms of coal. In 2017, a VGH surgeon, Dr. Andrea J. MacNeill, demonstrated that the use of desflurane at the hospital was a greater contributor to global warming than all the operating room energy requirements and consumable materials combined! VGH’s anesthesia team acted quickly and stopped using desflurane.

The committee’s second project looked to reduce waste of nitrous oxide, also known as “laughing gas.” Although it was rarely used for anesthesia and pain control, 95 per cent of the gas supply was lost due to leaks in the piped network before it reached patients. To address this, the committee replaced the existing network at Vancouver General Hospital (VGH) with a small local supply that is used only when needed. This move was widely supported and has an impact equivalent to removing 57 cars from the road each year.

Their third project took aim at reducing plastic waste that is unfortunately part and parcel of modern surgical care. The committee looked at the plastic circuits connecting the anesthesia breathing machine to the patient. Each circuit was 200 grams of plastic tubing that went into the waste bin at the end of each day. By sourcing antimicrobial circuits that are safely reusable for one week, the committee reduced this source of plastic waste five-fold!


Photo: Dr. Himat Vaghadia

Dr. Himat Vaghadia was one of the committee members who worked on the desflurane and circuits project.

We want to be good stewards of the environment, but we also have to be mindful of the cost of health care. These projects have allowed us to make a positive impact on both,” he says.

These projects can be replicated in other facilities and health organizations looking to reduce their environmental impact. Dr. Stewart Brown, who worked on the nitrous oxide project, notes,

I’ve not met any health-care workers who aren’t frustrated by the environmental impact our work causes. Where we can find ways to improve this, the support is incredible.”

The leadership by the VCH Department of Anesthesia has been remarkable, and it is hoped that other facilities and organizations will take notice of what is possible when subject matter experts combine their care for patients and planet together.