The Lancet Planetary Health, March 2025

Greenhouse gas impact from medical emissions of halogenated anaesthetic agents: a sales-based estimate

Climate change is affecting human and planetary health at an increasing rate. To this end, fulfilment of the Paris Climate Agreement and the Kigali Amendment of the Montreal Protocol will require an acute reduction in greenhouse gas emissions. Halogenated anaesthetic agents are hydrofluorocarbon greenhouse gases. The most potent of them, desflurane, is approximately 2600 times more potent than carbon dioxide over a 100-year period. The least potent clinically relevant alternative, sevoflurane, is roughly 140 times more potent than carbon dioxide over the same time period. Because the anaesthetic potency of desflurane is lower than that of sevoflurane, the greenhouse gas impact of desflurane in clinical practice is 40–50 times higher than that of sevoflurane.

Greater awareness of the greenhouse gas impact of anaesthesia, particularly halogenated anaesthetic agents, has prompted the World Federation of Societies of Anesthesiologists, the European Society of Anaesthesiology and Intensive Care, the Australian and New Zealand College of Anaesthetists, and the American Society of Anesthesiologists, among others, to call for changes in practice. Beginning in 2024 in the UK and in 2026 in the EU, the use of desflurane has been or will be strictly limited by policy or regulation.