Desflurance Guidance

Guidance from the College of Anaesthesiologists of Ireland Relating to Desflurane.

We all have a responsibility to urgently address the climate and biodiversity crises, particularly in the developed world as we are the main cause of both. The College of Anaesthesiologists of Ireland are mindful of the position taken by our colleagues in the Association of Anaesthetists and the Royal College of Anaesthetists to support the decommissioning of desflurane in the NHS. This is based upon their assessment that there are clinically safe, more environmentally friendly and cost-effective alternatives.

The College of Anaesthesiologists of Ireland have considered the following:

• The climate crisis is the largest and most prolonged threat to global health ever described. ⁽ⁱ⁾
• The range of agents and techniques available to anaesthesiologists to provide safe and effective anaesthesia and the estimated carbon footprints of these various agents/techniques.
• All the anaesthetic gases in common use are potent greenhouse gases but desflurane has by far the most potent atmospheric heating effect of these vapours. It has been determined that 1kg of desflurane contributes to atmospheric over-heating in the same amount as 2.5 tonnes of CO₂. ⁽ⁱⁱ⁾

New technologies may permit vapour capture and subsequent incineration or re-cycling of desflurane. In circumstances in which these technologies are not being used, the College considers that the use of desflurane is no longer justifiable. The College strongly advises its members and fellows to transition to more sustainable anaesthetic techniques.

• The Lancet Countdown on health and climate change: from 25 years of inaction to a global transformation for public health.
  Watts et al; Lancet (2018); 391: 581-630.
• Assessing the Impact on Global Climate from General Anaesthetic Gases.
  Andersen et al; Anesthesia & Analgesia (2012); 114(5):1081-85.