ABSTRACT
In 2019, the North East Anaesthesia Sustainable Healthcare (NEASH) Network was formed. Its aim is to encourage coordinated sustainability efforts. We comprise over 80 anaesthetists with representatives in every Trust in our region. The NHS accounts for 4% of UK carbon emissions. Two per cent of NHS emissions come solely from anaesthetic gases. In late 2020, we began a region-wide project to raise awareness of the environmental impact of general anaesthesia (GA) with the aim of reducing emissions throughout our geographical area. Methods NEASH performed a snapshot audit of 1 full week's GA data in early 2021. Consumed volatile agent, nitrous oxide (N2O) and total intravenous anaesthesia (TIVA) were converted into kilograms of carbon dioxide equivalents (kg CO2e) [1, 2]. Each Trust's emissions were divided by total GA time giving kg CO2e per hour (kg CO2e.h-1), allowing efficiency comparison between sites. We presented our results and the following messages to each Trust. Firstly, stop using desflurane and use N2O only when essential as these agents have the highest global warming potential (GWP). Secondly, we encouraged sevoflurane use as it has the lowest GWP of volatiles (followed by isoflurane);low fresh gas flows are essential. Thirdly, consider TIVA, as its GWP is lower than volatile GA. Although outside the scope of our audit, we reminded colleagues that local or regional anaesthesia have a lower CO2e than GA. In early 2022, we re-audited to assess the impact of our messages. Results The results of 5340 h of GA data are displayed in the table below. Discussion Due to increased operating post-COVID-19 and the inclusion of a hospital that was unable to participate in round 1, round 2 contained 787 more hours of data. Despite this, emissions of CO2e were 12.83 t lower, demonstrating an average hourly emission reduction of 61.1%. This was mainly driven by reduced desflurane and N2O use. Two hospitals in our region have since decommissioned N2O manifolds and two others are undertaking this process. Region-wide procurement data obtained by NEASH showed that three hospitals have ceased ordering desflurane. TIVA use remained broadly the same, which may be due to a lack of availability of equipment. This region-wide project is easily reproducible nationwide and could make significant contributions towards NHS net zero. (Table Presented).