Changing perioperative practice in the time of climate crisis

To reduce the healthcare sector's contribution to carbon emissions, many hospitals have advocated avoiding inhaled anesthetic agents with high greenhouse gas potential, such as desflurane and nitrous oxide; using low gas flows; and adopting alternative anesthetic techniques. However, limited evidence is available on how to implement these changes, which require both organizational and individual adjustment. We engaged our healthcare workers on the topic of climate change, and reviewed any change in their knowledge and attitudes towards environment-friendly use of inhaled anesthetic agents. We sent out a survey via email to our anesthetic staff to assess their baseline knowledge and opinions regarding inhaled anesthetic agents and climate change. We then provided an online education session, followed by a debate on whether to remove desflurane from use. The session was recorded and emailed to all staff. The impact of the intervention was subsequently assessed by repeating the knowledge and attitude survey. Of the 101 anesthetic staff members, 76 completed the initial survey and 54 completed the post-intervention survey. Using a pre-determined generated code, we matched 44 pairs of datasets for analysis (response rate 44%). We demonstrated an overall improvement in knowledge on the topic, and showed a positive attitude towards reducing the use of nitrous oxide. There was minimal attitude change on desflurane use, a considerable concern about risk shifting and limited support for total intravenous anesthesia as the default technique. As an initial step of a practice change process, this study raised climate change awareness and enabled our staff with differing opinions to feel involved and prepared for change. However, additional strategies may be required before initiating organizational changes, with the aim to provide environmentally sustainable practice while maintaining safe and high-quality perioperative patient care.