A true story: United States of America, early morning, Providence Hospital in Portland, Oregon. A middle-aged lady is lying on an operating table, surgeons are about to remove a stomach tumor. Doctor Brian Chesebro puts the anesthesia mask on her and says, “Now you're going to breathe into this mask, and I'm going to put sevoflurane into your airway.”
Sevoflurane is one of the most used gases in anesthesia: the other is desflurane.
Consider that only 5% of the gas delivered in the operating room is metabolized by the patient, the rest is sucked in by the ventilation system to avoid that it can also have effects on the operating team.
And then? Then it ends up in the atmosphere, along with the other greenhouse gases.
Sevoflurane and desflurane are very similar: the former requires more patient monitoring, but is not difficult to manage, in the end one is as good as the other. What anesthesiologists may not know is that desfluorane is much, much more harmful to the environment.
Doctor Chesebro, on the other hand, is interested in the discussion: he is a doctor who is very attentive to the environment and concerned about the future of the planet. For this reason he spent many hours researching anesthetic gases, and realized that desflurane can retain heat in the atmosphere 20 times more than sevoflurane and remains in the atmosphere for 14 years, while sevoflurane completes its cycle in just one year.
At that point he opened a large black notepad and wrote down all the gases used by his colleagues, with graphs on their use and their environmental impact, and showed them to his medical group: "all I did was show them some data . I didn't want to be pushy, just inform them."
One of the doctors who found the analysis interesting, Dr. Michael Hartmeyer says “I wish I had known before, my operating practice would have changed a long time ago”.
Among the data that struck Hartmeyer was the one on the production of greenhouse gases: the desflurane is equivalent to driving a fleet of 12 large SUVs during the entire duration of the operation. Using sevoflurane is equivalent to driving a medium-sized car: it's not quite as fuel-efficient as his Toyota Prius, a hybrid car, but at least it's not half an environmental disaster.
“I try to take precautions. I don't turn on too many lights, take shorter showers, or anything. I do what I can. But in my profession, changing the anesthetic gas is a very simple gesture that can have a gigantic impact."
Other colleagues in the hospital also based their choices on sevuflorane, and were even more pleased to know that it is also much cheaper. Each of them has produced savings for the facility of $13.000 per year: together they exceed half a million dollars in annual savings.
The Director of Providence Hospital, Lisa Vance, in announcing the official transition of sevuflorane as an anesthetic gas said that the change was not made for money reasons: it was made because the WHO said that climate change is the 1 ° global health problem of the 21st century.
Chesebro's efforts, which are slowly expanding to other hospitals, are all the more important as the fact that the American health sector is responsible for 10% of all greenhouse gas emissions in the country.
The counterarguments of pharmaceutical companies
One of the major producers of both gases, the Baxter International, says that providing a range of choice to patients is important: “after all,” reads his recent statement, “anesthetic gases have an impact equivalent to just 0,01% of fossil fuels.”
Even if it were small or large, why not reduce your impact on the environment anyway?
Data is the least contestable thing in the world. The data speaks. Using sevoflurane allowed Dr. Chesebro to release greenhouse gases equivalent to a 65 kilometer journey into the atmosphere. If she had used desflurane, it would have been like driving more than 1900 kilometers.
