Don’t use inhaled anesthetic agents with high global warming potential, such as desflurane and nitrous oxide.

Don’t use inhaled anesthetic agents with high global warming potential, such as desflurane and nitrous oxide.

Type of practice

Drugs

Age

Adult, Geriatric, Pediatric

Topic Area

Anesthesia, Analgesia, Resuscitation and Intensive Care

Desflurane and nitrous oxide can be effectively replaced with equally efficient but less environmentally harmful inhaled anesthetics, or with alternative anesthetic techniques such as total intravenous anesthesia or regional anesthesia. Starting from January 1, 2026, the use of desflurane as an inhaled anesthetic—whose Global Warming Potential (GWP) is more than 2,500 times that of CO₂—will be banned in the EU, except for justified medical reasons. Among currently available volatile anesthetics, sevoflurane has the lowest GWP. In general, inhalational anesthesia should always be administered using closed circuits and low fresh gas flows to optimize anesthetic consumption. Where feasible, scavenging and/or recycling systems for inhaled anesthetics should also be used.

Sources

1. White SM, Shelton CL, Gelb AW et al. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia 2022, 77, 201-212. doi:10.1111/anae.15598.
2. Regolamento (UE) 2024/573 del Parlamento Europeo e del Consiglio del 7 febbraio 2024 sui gas fluorurati a effetto serra, che modifica la Direttiva (UE) 2019/1937 e abroga il Regolamento (UE) n. 517/2014. https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ%3AL_202400573 (last accessed March 2025).
3. Ozelsel TJP, Ip VHY, Sondekoppam RV. "Green-gional" anesthesia: a lot greener than you think. Regional Anesthesia and Pain Medicine 2021; 46: 553-4.
4. European Society of Anaesthesiology and Intensive Care Sustainability Committee. Sustainability toolkit: how to reduce our carbon footprint in OR, hospital, and the planet 2025. https://esaic.org/wp-content/uploads/2025/01/Sustainability-Toolkit-v2.pdf . (last accessed March 2025).
5. NHS England » Guidance: Desflurane decommissioning and clinical use. March 2024. PRN01005 https://www.england.nhs.uk/publication/guidance-desflurane-decommissioning-and-clinical-use/ (last accessed March 2025).

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Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.