Reducing & Eliminating Desflurane Usage

Like other anesthetic gases, desflurane is detrimental to the environment. As a result, reducing or eliminating the use of desflurane can be an impactful approach to greening anesthesia and perioperative care.

If your hospital is interested in reducing costs and its environmental impact by eliminating desflurane usage, Ontario’s Anesthesiologists’ Environmental Sustainability Working Group is ready to help. We can provide resources, presentations and personal support from one of our members to help your greening efforts. Contact us today!

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Background Recommendations Benefits Processes Implementation History Resources and References

Background: Environmental Impact of Desflurane and Volatile Anesthetics

Desflurane is estimated to be responsible for 80% of the greenhouse effect from volatile anesthetic emissions.

Volatile anesthetics contribute significantly to the carbon emissions of healthcare facilities. In particular, desflurane has been identified as an agent with high global warming potential (GWP) of 2540: One gram of desflurane is the equivalent of 2,540 grams of carbon dioxide. This is roughly 20 times greater than that of sevoflurane, whose GWP is 144.

For reference, one MAC-hour of desflurane use is the estimated equivalent of driving 300 km, whereas one MAC-hour of sevoflurane is like driving only 7.5 km.

Recommendations

The following professional societies have released position statements regarding the reduction of harmful emissions, waste, and costs:

• Ontario’s Anesthesiologists

• American Society of Anesthesiologists

• World Federation of Societies of Anaesthesiologists

In November 2024, the Canadian Anesthesiologists’ Society released the following recommendations:

Benefits of Desflurane Usage Elimination/Phase-Out

Reducing/eliminating the use of desflurane is a key opportunity for reducing the environmental impact of perioperative and anesthetic care.

Several institutions have shown improvements in carbon-dioxide emissions through eliminating or phasing out desflurane. They include:

1. Decreased carbon emissions

   • In British Columbia, a decrease in desflurane use lowered each health authority’s carbon footprint by more than 50%.

2. Similar patient outcomes

   • Concerns have been raised by some anesthesiologists that the phase-out of desflurane could have a negative clinical impacts A review by the National Institute for Health and Care Excellence has found no high-quality evidence to suggest that desflurane has any significant clinical or therapeutic advantage over other general anesthetic agents in patients undergoing neurological procedures or those with BMI greater than 30.

Processes for Desflurane Usage Elimination/Phase-Out

Developing an initiative to decrease desflurane usage and decrease anesthesia-related carbon emissions involves the use of multiple strategies.

Strategies to implement desflurane phase-out may include:

• Education regarding the environmental impact of volatile anesthetics at departmental meetings

  • And via distribution of posters

• Journal club presentations on scientific evidence

• Gradual removal of desflurane vaporizers from individual operating rooms

Additionally, mitigation strategies for reducing carbon emissions include:

• Substituting desflurane with sevoflurane or isoflurane if volatile anesthetics are indicated

• Considering the use of total intravenous anesthesia as an alternative

• Minimizing anesthetic waste through lower fresh gas flow

History of Implementation

As the environmental impact of desflurane use has become established, several countries and jurisdictions have implemented desflurane phase-out initiatives. The first health service to ban desflurane was the Scotland National Health Services in March 2023, followed by England’s National Health Services in April 2024. In January 2026, the European Union officially banned the use of desflurane.

In Canada, the first province to stop purchasing desflurane was Newfoundland and Labrador in December 2024. The next month, the Northwest Territories announced that it would be the first jurisdiction to fully phase out desflurane.

Although several hospitals and healthcare institutions have since removed desflurane from their formularies, no further province-wide measures have been implemented.

In Ontario

The first institution in Ontario to report the removal of desflurane from formulary was Health Sciences North in Sudbury. Subsequently, with a growing number of hospitals having eliminated desflurane from routine use.

The Ontario Anesthesiologists’ Environmental Sustainability Working Group now maintains a registry of participating facilities. Explore it below (to see the full list of centres, select the “View larger map” option). If your facility has reduced/eliminated desflurane and you are not listed, please contact us.

Resources and References