Operating rooms are the main sources of greenhouse gases. Penn is eliminating a form of anesthesia that hangs in the air for more than a decade after use.

Health systems in the Philadelphia area are phasing out a common anesthetic gas that has hung in the atmosphere for 14 years.

Desflurane is the most potent greenhouse gas found in hospitals, which are increasingly engaged in efforts to reduce their carbon footprint.

Desflurane was favored by doctors because it leaves the body quickly, allowing patients to wake up within minutes after the anesthetic gas is turned off. But another inhaled anesthetic, sevoflurane, is now considered a better choice for most patients because it is less likely to cause nausea and is less irritating to the airways. Sevoflurane is also much less harmful to the environment, dispersing into the atmosphere in just over a year.

Children’s Hospital of Philadelphia and Virtua Health have already phased out desflurane. Virtua is increasingly moving away from all inhaled anesthetics and encouraging doctors to opt for anesthetic drugs that can be administered intravenously, without emitting greenhouse gases.

Main Line Health has also scaled back its use of desflurane, although system hospitals plan to keep it on hand for select cases.

Penn Medicine has phased out desflurane at four of its six hospitals Hospital of the University of Pennsylvania, Pennsylvania Hospital, Penn Presbyterian Medical Center and Princeton Medical Center. The two Penn hospitals that still use desflurane, Chester County Hospital and Lancaster General Hospital, will stop using it at the end of the year.

The push to eliminate the harmful greenhouse gas is part of broader climate initiatives at Philadelphia-area hospitals, with research showing the health care sector contributes about 9 percent of national gas emissions greenhouse effect, according to the US Department of Health and Human Services.

Penn and Main Line Health last month joined more than 130 healthcare organizations nationwide that have signed on to the 2022 Health Sector Climate Commitment created by the White House and the Department of Health and Human Services.

Jefferson Health is part of a sustainability initiative by The Joint Commission, a leading hospital accrediting organization.

There’s also a business case for being more environmentally friendly: Penn hopes to save millions of dollars through its emissions reduction initiatives.

Of course, it’s the right thing to do, said Greg Evans, the University of Pennsylvania Health System’s corporate director of sustainability. Being environmentally conscious doesn’t have to cost money. In fact, it can mean significant savings.

How a healthcare system reduces emissions

The National Health Sector Climate Commitment calls for healthcare organizations to halve greenhouse gas emissions by 2030 and eliminate them by 2050.

Penn expects the switch from electricity to solar power to account for more than half of its emissions reduction. Penn recently finalized a 25-year solar contract that will provide 70 percent of the energy for its hospitals and buildings in Philadelphia and save a couple of million dollars over the course of the contract, Evans said.

Penn has also found energy savings in its operating rooms, which represent a significant portion of hospital waste because they require advanced air filtration, powerful lights, and produce a lot of medical waste from individually wrapped tools, many of which cannot be reused. .

Staff now turn off air filtration systems when operating theaters are not in use overnight and on weekends. Hospitals are reducing the amount of medical waste that needs to be disposed of especially by using smaller containers, to ensure that they are only used for dirty materials and not for regular trash.

Some single-use medical supplies, such as pulse oximeters and scalpels, are now collected and sent to a facility that disinfects and refurbishes them, then sells them back to the healthcare system at a reduced price.

Other measures, such as incentivizing employees to take public transportation, reducing medical waste, and phasing out high-polluting drugs such as desflurane will also be critical to achieving Penn’s ambitious zero-emissions goal.

Gradual elimination of a powerful anesthetic drug

Penn can save tens of thousands of dollars by eliminating the anesthetic gas desflurane. For example, his hospital in Princeton saves about $40,000 a year by no longer buying the drug.

Princeton began exploring the idea of ​​phasing out desflurane by 2021, after national anesthesia organizations began publishing findings about the drug’s environmental toll, said Bridget Ruscito, chair of Princeton Medical Center’s department of anesthesiology. .

Desflurane is inhaled through a breathing tube. It can be used alone, but is most often used with an IV anesthetic. Doctors once favored it because patients can recover more quickly, which is especially important if they don’t spend the night in the hospital after the procedure. But it can irritate the respiratory tract and cause nausea.

Sevoflurane, another anesthetic gas, is now preferred in most cases. It dissipates in the atmosphere after a little more than a year, compared to the decade or more desflurane stays in the air.

Ruscito first asked Princeton providers to consider sevoflurane or other alternatives before using desflurane and to opt for a slow-flow ventilator if they chose to use desflurane.

When no one seemed to back down, he asked the department: Would anyone mind if we got rid of it entirely?

Princeton stopped using desflurane in 2022 and we haven’t looked back, Ruscito said.