Greener Anesthesia Reshapes Surgical Sustainability

Operating rooms rank among the most resource-intensive spaces in any hospital, yet they rarely appear in climate-policy discussions. New data from Cedars-Sinai show how quickly that can change when clinical leadership, data transparency, and procurement policy align. By eliminating virtually all use of desflurane and sharply curbing nitrous oxide, the Los Angeles health system removed an estimated 2,200 metric tons of carbon dioxide equivalents in just four years, roughly the annual emissions of 400 U.S. homes.

Why Anesthetic Gases Matter

The health sector generates roughly 8 percent of U.S. greenhouse-gas output, according to a Health Affairs analysis of energy, supply-chain, and clinical sources. (Health Affairs) Although anesthetic gases account for a small fraction of total hospital emissions, they punch above their weight because they escape unscathed into the atmosphere. The American Society of Anesthesiologists reports that desflurane’s warming potential is twenty-fold greater than sevoflurane’s. (American Society of Anesthesiologists) One hour of desflurane can carry the same carbon cost as driving a gasoline-powered car nearly 190 miles. (Beverly Press)

Nitrous oxide, meanwhile, persists in the atmosphere for a century and is now the single largest ozone-depleting release from modern healthcare facilities. (American Society of Anesthesiologists) These characteristics make inhaled anesthetics low-hanging fruit for decarbonization efforts: clinical substitutes exist, and transition requires no capital-intensive retrofits.

The Cedars-Sinai Playbook

Peer-to-peer engagement. In 2021, anesthesiologists Jacklyn Ma, MD, and Michael Kissen, MD, began sharing emissions data at departmental rounds, framing gas choice as a patient-safety and population-health issue rather than a regulatory mandate.

Data-driven formularies. Pharmacy, perioperative leadership, and the anesthesia department agreed to retire desflurane completely in 2023. Annual utilization fell from 1,200 bottles in 2021 to fewer than a dozen last year, a 99 percent reduction.

Targeted phase-out of nitrous oxide. Pediatric and obstetric teams piloted alternative analgesia pathways, while facilities staff decommissioned rarely used central nitrous lines to prevent waste. Resulting emissions plunged from 1,111 to 234 metric tons of CO₂ equivalent between 2021 and 2024.

Clinical Quality and Patient Safety

Sevoflurane’s pharmacokinetics differ minimally from desflurane’s for most patients. Cedars-Sinai tracked postoperative nausea, extubation times, and length of stay across thousands of cases and found no statistically significant changes after desflurane elimination. That outcome reinforces evidence from multicenter studies showing equivalent recovery profiles when fresh-gas flows are optimized.

Nitrous oxide posed distinct occupational hazards, ambient levels inside dental and pediatric suites have exceeded recommended thresholds for decades, so phasing it out lowered exposure risk for nurses, anesthetists, and surgeons alike.

Financial Leverage

Converting to lower-impact agents yielded immediate cost savings: desflurane’s wholesale price averages three to four times that of sevoflurane. Lower fresh-gas flow rates further suppressed spend on oxygen and medical air. Even after accounting for staff training and protocol redesign, finance teams projected a positive return on investment within the first fiscal year.

Regulatory Momentum and Market Signals

The World Health Organization now labels climate change the greatest threat to global health, urging providers to treat emissions reduction as a core quality metric. (World Health Organization) In the United States, the Centers for Medicare & Medicaid Services has begun soliciting feedback on voluntary climate-reporting frameworks, and several state purchasing consortia are piloting “carbon clauses” in drug contracts. Collectively, these signals put laggard systems on notice: what is voluntary today could become a licensure or payment expectation tomorrow.

Technology and Process Innovations

• Automated fresh-gas flow governors adjust volatile delivery to the minimum required for target anesthetic depth, reducing waste by up to 50 percent in real-world trials.
• Closed-loop vapor capture systems, under evaluation at academic centers, promise to collect and recycle exhaled anesthetics, transforming what is now pure loss into reusable product.
• Lifecycle labeling—akin to nutrition facts—may soon appear on surgical kits, implants, and medications. Cedars-Sinai executives are collaborating with Harvard Business School researchers to quantify embedded emissions across supply chains so clinicians can choose lower-carbon options without compromising outcomes.

Lessons for Health-System Leaders

1. Hard-stop formularies accelerate culture change. Removing high-carbon drugs from automated dispensing cabinets avoids the “just this once” exception mentality.
2. Real-time dashboards sustain momentum. Publishing weekly agent-usage and flow-rate metrics keeps competitive surgeons and anesthesiologists engaged.
3. Align sustainability with safety and cost. Framing decarbonization as a triple win, patients breathe cleaner air, staff face fewer occupational exposures, and hospitals cut purchasing spend, draws support beyond green champions.

Beyond the Operating Room

Anesthesia is merely the tip of the clinical-emissions iceberg; sterilization processes, implant selection, and single-use device preferences offer larger absolute savings. Cedars-Sinai’s orthopedics department has already begun mapping the carbon intensity of hip-replacement trays, aiming to shrink kit size without affecting infection rates or procedural efficiency.

A Closing Imperative

Healthcare’s social license rests on the promise to do no harm. Continuing to choose high-impact anesthetic gases when safer, cheaper, and cleaner alternatives exist violates that covenant. Cedars-Sinai’s rapid descent in anesthesia emissions proves that decisive action can be swift, clinically sound, and financially rational. The next step belongs to every perioperative team still tethered to legacy practice: audit, educate, and eliminate because cleaner air is a treatment worth prescribing.