ABSTRACT
Anaesthesia is associated with the routine use of volatile anaesthetic agents, all of which are potent greenhouse gases in varying degrees. Desflurane, in particular, has a high global warming potential and in recent years, there has been a global movement to reduce or remove its usage entirely from operating theatres. We work in a large tertiary teaching hospital in Singapore with deeply entrenched practices of using desflurane to facilitate high turnover of operating theatre cases. We launched a quality improvement project to (1) reduce the median usage of desflurane by 50% (by volume), and (2) reduce the number of theatre cases administering desflurane by 50% over a period of 6 months.We collected baseline data to determine departmental monthly median usage of desflurane. We then deployed sequential quality improvement methods to educate staff and to eliminate misconceptions, as well as to promote a gradual cultural change.We successfully reduced monthly median desflurane usage from 31.5 L to 12.2 L per month (61.3% reduction) within our targeted time frame. We also achieved a reduction in the number of theatre cases using desflurane by approximately 80%. This translated to significant cost savings of US$195 000 per year and over 840 tonnes of carbon dioxide equivalents saved.Healthcare is a resource intensive industry. Anaesthetists are well placed to play an important role in reducing healthcare-related carbon emissions by choosing anaesthetic techniques and resources responsibly. Through multiple Plan-Do-Study-Act cycles and a persistent, multifaceted campaign, we achieved a sustained change in our institution.
