Sustainability Standards in Pediatric Anesthesia: Quality Initiative to Reduce Costly Environmentally Harmful Volatile Anesthetics

Authors

Andrew T. Waberski, From the George Washington School of Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, D.C.
Sophie R. Pestieau, From the George Washington School of Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, D.C.
Caroll Vazquez-Colon, From the George Washington School of Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, D.C.
Jessica Cronin, From the George Washington School of Medicine, Department of Anesthesiology, Pain, and Perioperative Medicine, Children's National Hospital, Washington, D.C.
Barbara H. Braffett, Department of Epidemiology, Milken Institute School of Public Health, The Biostatistics Center, George Washington University, Washington, D.C.

Document Type

Journal Article

Publication Date

1-1-2023

Journal

Pediatric quality & safety

Volume

8

Issue

6

DOI

10.1097/pq9.0000000000000708

Abstract

BACKGROUND: The emission and entrapment of greenhouse gases (GHG) inside the atmosphere is one of the leading causes of global warming. Commonly administered anesthetics have global warming potential up to 2,000 times greater than carbon dioxide. This Quality Improvement (QI) initiative aimed to develop a set of sustainability standards to reduce volatile anesthetic GHG emissions and costs at a children's hospital. METHODS: In January 2020, the QI project team implemented education sessions for clinical staff on the environmental impact of volatile anesthetics, bedside clinical reminders, resource guides on sustainable anesthesia practices, preset low-flow gas levels on anesthesia machines, relocated and reduced the number of available vaporizers, and implemented policies to standardize clinical practice. Using hospital pharmacy purchase order data between 2018 and 2022, GHG emissions and costs from three commonly used volatile anesthetics (Isoflurane, Sevoflurane, and Desflurane) were compared using metric ton carbon dioxide equivalents. RESULTS: During 3 years, GHG emissions from volatile anesthetics were significantly reduced by 77%, with most of the reduction attributed to the reduced use and eventual elimination of Desflurane. Purchase costs were also significantly reduced during this period by 41%. CONCLUSIONS: This QI project successfully decreased GHG emissions over 3 years by simultaneously reducing the use of costly and environmentally harmful volatile anesthetic, Desflurane, and increasing the use of low-flow anesthesia. This study addresses our anesthesia practices and healthcare system's impact on the pediatric population and proposes simple interventions to mitigate the negative consequences of current practices.

APA Citation

Waberski, Andrew T.; Pestieau, Sophie R.; Vazquez-Colon, Caroll; Cronin, Jessica; and Braffett, Barbara H., "Sustainability Standards in Pediatric Anesthesia: Quality Initiative to Reduce Costly Environmentally Harmful Volatile Anesthetics" (2023). GW Authored Works. Paper 3720.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3720

Department

Anesthesiology and Critical Care Medicine