How Hospitals Can Dramatically Reduce Their Greenhouse Gas Emissions

By reevaluating how anesthesia gases are used for surgery, can hospitals make a real environmental impact?

In the operating room, Diane Gordon, MD, a pediatric anesthesiologist, prepares the anesthesia machine as a steady hum fills the air. Dr. Gordon isn’t just performing a complex procedure to ensure a child’s safety during surgery — she’s protecting the planet by helping Children’s Hospital Colorado reduce its greenhouse gas emissions.

Dr. Gordon has always been interested in heart and lung physiology, and perhaps most importantly, she’s driven by the desire to have an immediate impact.

“I want to be able to fix it, right then and there,” Dr. Gordon says.

Fifteen years ago, as a resident in Utah, she began to learn about the environmental impact of anesthesia gases and knew she had to change her practice. Now, at Children’s Colorado, she’s on the forefront of a nationwide initiative called Project SPRUCE: Saving Our Planet by Reducing Carbon Emissions.

The operating room accounts for 40% of a hospital’s greenhouse gas emissions. Inhaled anesthesia agents, like desflurane and nitrous oxide, provide safe and effective anesthesia for patients but are also potent greenhouse gases, hundreds to thousands of times worse than carbon dioxide.

Dr. Gordon’s first project, which began at Children’s Colorado in 2018, was to reduce the use of desflurane, the most potent of the anesthesia gases. Within four months, the hospital reduced its greenhouse gas emissions by 50%. In 2019, Children’s Colorado stopped its use of the gas, reducing annual greenhouse gas emissions by 803.7 metric tons of CO2 equivalent — the same emissions as two million miles driven.

After Dr. Gordon removed desflurane, she shifted her focus to delivering anesthesia as efficiently as possible by reducing the amount of wasted gas, which is vented directly into the atmosphere. To eliminate waste, Dr. Gordon is working to lower the hospital’s flow rates on anesthesia machines.

“Anesthesia machines are designed to allow re-breathing. You’re recycling gas. It’s breathed in and then they breathe it back out. If the fresh gas flow is set really high, it can’t be recycled. We want to encourage people to use a gas that’s not as environmentally harmful and to use lower fresh flows,” Dr. Gordon says.

Right now, Dr. Gordon is encouraging anesthesiologists to use sevoflurane instead of desflurane as it's less harmful and desflurane holds no clinical advantage. The case to get rid of desflurane is compelling; not only does it benefit the environment, but it also results in a significant cost-savings.

“We’ve shown that you don’t really need desflurane as an anesthetic,” Dr. Gordon says.

Children’s Colorado has also reduced the use of nitrous oxide, known as laughing gas, by 70%. Nitrous oxide is a very potent greenhouse gas that stays in the atmosphere for over 100 years and contributes to the depletion of the ozone layer. Dr. Gordon’s next project, in collaboration with Sustainability Manager John Hudgens, is switching to portable tanks of nitrous oxide instead of relying on the central pipeline in the hospital’s walls. By design, the central pipeline leaks nitrous oxide to prevent excessive pressure buildup. This new system will further reduce the amount of nitrous released into the atmosphere.

“It takes a lot more work, but we’re making progress. We’re getting closer to that goal of deactivating the central nitrous oxide pipeline,” says Dr. Gordon.

The success at Children’s Colorado serves as a blueprint for other hospitals. Currently, there are 10 hospitals participating in Project SPRUCE. Through software integrated with EPIC, participating hospitals are able to track their fresh gas flow, agent and concentration in real time.

“It helps a lot to show people the impact of the change we’re making,” Dr. Gordon says.

Dr. Gordon remains optimistic, believing each change contributes to a larger movement toward environmental responsibility in the medical community. With the help and support of leadership at Children’s Colorado, she’ll continue to inspire others to make a meaningful difference.