Greenhouse gas impact from medical emissions of halogenated anaesthetic agents: a sales-based estimate.

Summary

Using global sales data (2014–2023) from 91 countries, the authors estimate a 27% reduction in carbon dioxide–equivalent impact from halogenated anesthetics, driven largely by decreased desflurane use in high-income countries. The work highlights rising desflurane use in some middle-income settings and identifies replacement with sevoflurane as a major mitigation lever.

Key Findings

• Global greenhouse gas impact from halogenated anesthetics fell by 27% over 2014–2023.
• Decreased desflurane use in high-income countries largely drove the decline.
• Some middle-income countries showed increased desflurane use, suggesting targeted mitigation needs.
• Replacing desflurane/isoflurane with sevoflurane could markedly reduce climate impact.

Clinical Implications

Supports eliminating desflurane formularies, favoring sevoflurane or TIVA where feasible, adopting low-flow anesthesia, and targeting education and policy in middle-income regions to curb rising desflurane use.

Limitations

• Sales data are proxies for use and may not perfectly reflect actual emissions
• Coverage excludes some countries; assumptions in conversion factors may introduce uncertainty

Future Directions

Link sales/use to measured waste gas emissions, expand coverage to 100% of countries, and evaluate impacts of low-flow protocols and alternative techniques (e.g., TIVA) on real-world emissions.