Healthcare sectors will face significant additional challenges due to climate change in the near future. In 2024, temperatures consecutively exceeded the 1.5°C threshold, even as policymakers implemented their net-zero policies effectively. The production of fossil fuels continues to rise while coal, oil, and gas corporations conduct large-scale profit-generating operations. Healthcare contributes 4.4% of global greenhouse gas emissions, along with 5.2% of Germany’s emissions.
Reducing the anesthesiology department’s carbon footprint requires energy conservation, renewable solutions, and discontinuing volatile anesthetic use. After administration, all general anesthetic agents, including hydrofluorocarbons (HFCs) and chlorofluorocarbons (CFCs), escape into the environment because the body cannot metabolize them (less than 5% is metabolized).
Volatile anesthetics possess a higher value of global warming potential (GWP) when compared to carbon dioxide (CO2). Our research spanned all three clinical campuses of Charité (CCM, CBF, and CVK) to examine which external and internal methods, together with top-down and bottom-up approaches, best sustained anesthetic consumption levels. This study focused on propofol, sevoflurane, isoflurane, and desflurane, and the research team monitored the different interventions that influenced anesthesiologists’ operational procedures at each campus. The assessment of anesthetic consumption throughout Q1, Q2, Q3, and Q4 between 2015 and 2023 yielded the carbon footprint (CO2e).
The analysis covers four quarters from 2015 until the completion of 2023, where data from separate facilities and total results are presented. The intervention schedule began in September 2018, during the fourth quarter before it ended, with the last intervention in March 2023. The period allowed us to establish a baseline before the roll-out of Charité anesthesiology department education programs in 2018. We used our information from our internal business unit and pharmacy department, and they supplied us with data sets that held no patient identifiers. Our dataset was independent of any patient data.
The reduction of volatile anesthetic CO2e emissions reached 90.3% from 2015-2017 until 2023. The emissions declined from an average of 1,470 tons in the period of 2015 to 2017 to 191 tons in 2022 and 142 tons in 2023. The primary reason for emission reduction stemmed from removing desflurane and replacing it with sevoflurane or propofol while implementing regional anesthesia appropriately to increase patient safety. It experienced its most significant and fastest changes after adopting a new direction from the top of the administrative hierarchy. The total spending on anesthetics experienced a significant reduction between 2015 and 2023 from €541,102 ($594,238) initially to €281,646 ($309,303) eventually.
Between 2018 and 2023, volatile anesthetics in Charité’s three clinical campuses achieved substantial CO2e footprint reductions between 87% and 90%. The healthcare team received ongoing awareness about how these anesthetics affected global warming. The most rapid and lasting enduring reductions (within 3 to 6 months duration) followed top-down administrative decisions were implemented. After both “bottom-up” interventions from external or internal sources, there was sometimes a negative impact on these interventions within month periods.
With sustained efforts, both external and internal “bottom-up” practices can effectively reduce the CO2e emissions of volatile anesthetics. At the same time, a significant cost reduction was observed due to changes in anesthetic use by anesthetists. Anesthesia clinics lowered their CO2e emissions after anesthesiologists received training about volatile anesthetic emissions, especially desflurane’s negative impacts on the climate. These educational campaigns led to both reduced carbon dioxide emissions from anesthetics and decreased the cost of yearly anesthetic procurement.
References: Schwiethal A, Treskatsch S, Michael J, Höft M, Spies CD, Koch S. The power of education to reduce the carbon footprint of volatile anesthetics in clinical practice. Anesth Analg. 2025;10.1213/ANE.0000000000007375. doi:10.1213/ANE.0000000000007375
