Four years later, the Sustainable Anesthesia for the Environment (SAFE) team continues to turn ideas into action for patients and the planet.
Health care is responsible for a significant share of greenhouse gas emissions, and anesthetic gases are among the most carbon-intensive products used in the operating room. At Vancouver General Hospital (VGH) and UBC Hospital (UBCH), a group of anesthesiologists is demonstrating that reducing environmental impact can go hand in hand with improving patient care.
Inspired by growing international evidence on sustainable anesthesiology, a small group of clinicians and staff within VGH and UBCH Department of Anesthesiology has spent the past four years identifying and implementing initiatives to reduce emissions, waste, and resource use, recognizing the close connection between environmental sustainability and long-term human health. Their earlier successes included eliminating desflurane, nitrous oxide leaks, and significantly cutting operating room plastic waste.
Three years on, the team continues to build on that foundation, demonstrating that sustainable change is an ongoing journey.
This work has taken us to parts of the hospital we didn’t know existed and connected us with colleagues from nursing, medical device reprocessing, infection prevention and control, facilities maintenance and operations, procurement and biomedical engineering, says Dr. Stewart Brown. “These relationships have helped us understand the complexity and competing interests when pushing for sustainable health-care changes.”
Among their proudest achievements is the expansion of Total Intravenous Anesthesia (TIVA), which replaces inhaled anesthetic gases with intravenous medications. To support adoption, Dr. Shamir Karmali , a colleague and team member, developed a comprehensive e-learning education module and practical training resources to help clinicians build confidence with the technique. The result? TIVA use increased from 10% of all general anesthetics to 20%. Volatile gas usage dropped by 11% during that same period.
TIVA can provide clinical benefits, including reduced postoperative nausea, reduced recovery times for patients in the post-anesthetic care unit, while generating significantly lower emissions than conventional anesthetic gases,” says Dr. Asim Iqbal, affectionately known as a TIVA Diva.
Not every idea has succeeded. Investigations into PVC recycling revealed the complexity of processing the material and the limited recycling infrastructure currently available in western Canada. Efforts to reintroduce reusable airway devices encountered operational challenges related to reprocessing capacity and infection prevention requirements. Rather than viewing these as failures, the team sees them as valuable lessons that can help other anesthesiologists focus their efforts where the greatest impact is achievable.
Today, the group is exploring new opportunities, including reducing the use of high-emission salbutamol inhalers in perioperative care and integrating environmental sustainability concepts into the education of future anesthesiologists. The team also hopes to better measure and evaluate the impact of its initiatives to help spread successful practices across health-care organizations.
What impresses me most about this team is their continuous search for how to deliver exceptional patient care while reducing environmental impact.” says Andrea MacNeill, Planetary Health Medical Director at VCH. “Their commitment, creativity, and perseverance have shown that planetary health is not separate from clinical excellence, it is part of it.”
As the group continues to share knowledge, test new ideas, and learn from both successes and trials, their work offers a powerful example of how clinical teams can sustain momentum and help build a healthier future for patients and the planet.
