NHS England is banning desflurane in a bid to reach its net zero target, despite a climate scientist saying concerns are unfounded.
Desflurane is 2,500 times more potent as a greenhouse gas than carbon dioxide, and the NHS says it is ‘decommissioning’ the anaesthetic by early 2024 to help reduce ‘harmful emissions’.
It follows Scotland, which became the first country in the world in March 2023 to ban desflurane in hospitals due to its environmental impact.
According to NHS analysis of desflurane use in 2020, banning desflurane across NHS hospitals in England will cut harmful emissions equivalent to those caused by powering 11,000 homes yearly.
But Professor Dame Julia Slingo, a British meteorologist and climate scientist, said: ‘NHS directives to ban desflurane are not supported by climate science and should be reversed. The use of desflurane should be based on what is best for the patient.’
According to NHS England, desflurane is ‘one option used by anaesthetists to put patients to sleep safely, but it has a global warming potential 2,500 times greater than carbon dioxide’.
The health service adds: ‘Over the course of a decade, emissions saved through the elimination of desflurane would be equivalent to those that result from powering every home in Plymouth for a year.’
Prof Dame Julia, whose daughter Mary is a senior anaesthetic registrar in Hampshire, told a conference of doctors that anaesthetic gases ‘have no climate impact’.
They have ‘a vanishing[ly] small effect… lifetimes are too short and concentrations too low,’ she added.
Her speech was applauded by anaesthetists at the conference in September, despite their professional bodies, the Royal College of Anaesthetists and the Association of Anaesthetists, supporting the plan.
Dr Nick Fletcher, a consultant in London, said desflurane was helpful for ‘super-obese patients’.
He said: ‘Banning it removes a useful agent for patient care without a wider environmental benefit.’
The NHS believes there are readily available safe and clinically effective alternatives to desflurane.
They added that it is working with the National Institute for Health and Care Excellence (NICE) and other professional bodies to ensure the change is implemented safely.
Generally, anaesthetic and medical gases account for around 2% of all NHS emissions.
Two years ago, the climate scientist and her anaesthetist daughter made their point in a letter to the Guardian, noting that: ‘In the case of anaesthetic gases, there seem to be three conditions that should be met before a change in practice: (1) Are there clinical benefits to the patient? (2) Are there economic benefits to the NHS (3) Are there wider environmental benefits – for example, is there a reduction in non-recyclable/non-biodegradable waste and no increase in hidden carbon emissions from the manufacture of alternative practices?’
At the time, they concluded that ‘invoking climate change as a reason for abandoning the use of anaesthetic gases does not hold up scientifically’.
In a blog published on the NHS England website at the start of 2023, Chief Sustainability Officer of the NHS, Dr Nick Watts, Professor of peri-operative medicine at University College London Ramani Moonesing and Director of Medicines Policy and Strategy for NHS England Claire Foreman wrote:
‘Anaesthetic and analgesic practices account for 2% of the NHS carbon footprint. If the NHS is to deliver on its world-first net-zero ambition – and play its crucial part in reducing the health impacts of climate change – it must address emissions associated with this specialty. Desflurane, a volatile anaesthetic used for surgery, is a good place to start. It’s one option used by anaesthetists to put patients to sleep safely, but it has a global warming potential 2,500 times greater than carbon dioxide.’
According to the Royal College of Physicians, more than 40 NHS trusts have already stopped using the environmentally harmful anaesthetic gas.
Over the last three to four years, the use of desflurane across the NHS has fallen from 20% of all anaesthetic gases used to just 3%.
The Royal College’s March 2023 document, RCP view on healthcare sustainability and climate change, suggests that: ‘Over a decade, emissions saved through the elimination of desflurane would be equivalent to those resulting from powering every home in Plymouth for a year.’
Credit: Met Office
