Global Warming Potential of Inhaled Anesthetics: Application to Clinical Use
Abstract
BACKGROUND: Inhaled anesthetics are recognized greenhouse gases. Calculating their relative impact during common clinical usage will allow comparison to each other and to carbon dioxide emissions in general. METHODS: We determined infrared absorption cross-sections for sevoflurane and isoflurane. Twenty-year global warming potential (GWP(20)) values for desflurane, sevoflurane, and isoflurane were then calculated using the present and previously published infrared results, and best estimate atmospheric lifetimes were determined. The total quantity of each anesthetic used in 1 minimal alveolar concentration (MAC)-hour was then multiplied by the calculated GWP(20) for that anesthetic, and expressed as "carbon dioxide equivalent" (CDE(20)) in grams. Common fresh gas flows and carrier gases, both air/oxygen and nitrous oxide (N2O)/oxygen, were considered in the calculations to allow these examples to represent common clinical use of inhaled anesthetics. RESULTS: GWP(20) values for the inhaled anesthetics were: sevoflurane 349, isoflurane 1401, and desflurane 3714. CDE(20) values for 1 MAC-hour at 2 L fresh gas flow were: sevoflurane 6980 g, isoflurane 15,551 g, and desflurane 187,186 g. Comparison among these anesthetics produced a ratio of sevoflurane 1, isoflurane 2.2, and desflurane 26.8. When 60% N2O/40% oxygen replaced air/oxygen as a carrier gas combination, and inhaled anesthetic delivery was adjusted to deliver 1 MAC-hour of anesthetic, sevoflurane CDE(20) values were 5.9 times higher with N2O than when carried with air/O2, isoflurane values were 2.9 times higher, and desflurane values were 0.4 times lower. On a 100-year time horizon with 60% N2O, the sevoflurane CDE(100) values were 19 times higher than when carried in air/O2, isoflurane values were 9 times higher, and desflurane values were equal with and without N2O. CONCLUSIONS: Under comparable and common clinical conditions, desflurane has a greater potential impact on global warming than either isoflurane or sevoflurane. N2O alone produces a sizable greenhouse gas contribution relative to sevoflurane or isoflurane. Additionally, 60% N2O combined with potent inhaled anesthetics to deliver 1 MAC of anesthetic substantially increases the environmental impact of sevoflurane and isoflurane, and decreases that of desflurane. N2O is destructive to the ozone layer as well as possessing GWP; it continues to have impact over a longer timeframe, and may not be an environmentally sound tradeoff for desflurane. From our calculations, avoiding N2O and unnecessarily high fresh gas flow rates can reduce the environmental impact of inhaled anesthetics.
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Higher concentrations of desflurane are required to deliver the same clinical effect.
“Thus, higher concentrations are required to deliver the same clinical effect.38”
From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [38]
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- Authors
- Ryan, S. M., & Nielsen, C. J.
- Affiliations
- University of California, San Francisco (US)
- University of Oslo (NO)
- Corresponding author
- Ryan, Susan M.
- ORCID
- Nielsen, Claus J.
- Venue
- Anesthesia & Analgesia
- Published
- 2010-07
- Volume
- 111
- Issue
- 1
- Pages
- 92-98
- ISSN
- 0003-2999 (ISSN-L)
- OpenAlex
- W1983249815
- Cited by
- 340
- References
- 20
- Citations by year
- 2026: 34 · 2025: 32 · 2024: 40 · 2023: 37 · 2022: 34 · 2021: 18 · 2020: 22 · 2019: 27 · 2018: 8 · 2017: 11 · 2016: 11 · 2015: 7 · 2014: 12 · 2013: 16 · 2012: 18
- FWCI
- 19.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Surgery › Biomedical and Chemical Research
- Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
- Keywords
- inhalational anesthetics, global warming potential, greenhouse gas emissions, sevoflurane, isoflurane, desflurane, CO2 equivalent, infrared absorption cross sections, atmospheric lifetime, fresh gas flow
- MeSH terms
- Sevoflurane, Desflurane, Algorithms, Anesthesia, Inhalation, Isoflurane, Methyl Ethers, Nitrous Oxide, Practice Patterns, Physicians', Spectrophotometry, Infrared, Anesthetics, Inhalation, Global Warming
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