Proponents of environmental sustainability in surgery have long believed that facilities should reduce their use of high-emission anesthetic gases such as desflurane and nitrous oxide. A new study presented at the ANESTHESIOLOGY 2026 annual meeting suggests they’re correct.
The researchers compared one health system’s anesthetic use, estimated emissions, costs and patient outcomes in 2021 with results from January 2022 through October 2025—after the health system began implementing changes to reduce its emissions. The study included 145,917 anesthetic episodes.
They found that after the changes, the health system’s average total emissions dropped from 57.6 kilograms of carbon dioxide equivalent (kgCO2e) per anesthetic episode in 2021 to 31.6 kilograms after the intervention—a 45% reduction. Desflurane use fell from 23.8% to 9.81% of cases, while sevoflurane use increased from 82.4% to 93.1%.
The American Society of Anesthesiologists (ASA)—which promoted the study in a press release you can read in full here—stated that by late 2025, the health system surpassed its goal of reducing emissions by 50%. “Spending on inhaled anesthetics fell from $628,588 in 2021 to $379,010 in 2024, a nearly 40% savings,” ASA noted.
The changes had virtually no impact on patient safety, patient experience or quality, with ASA noting that “the researchers found patients continued to recover from surgery safely, with no increase in recovery room stays, hospital stays, breathing tube reinsertion, awareness or postoperative nausea and vomiting.”
“Our findings show that hospitals can take meaningful steps to reduce the environmental impact of surgery without compromising safety or quality,” stated Etta Hanlon, MS, lead study author and a researcher at Virginia Tech Carilion School of Medicine, Roanoke. “By making practical changes in anesthetic selection, reducing waste and giving anesthesiologists clear feedback, we reduced emissions and costs while maintaining strong patient outcomes.”
The findings suggest that greener anesthesia does not require costly technology, added ASA.
“Patients shouldn’t have to choose between environmentally responsible healthcare and safe, high-quality care,” said Sara Wohlford, director of sustainability at Carilion Clinic. “These are changes health systems and clinicians can make behind the scenes, allowing patients to benefit from more sustainable care without having to do anything differently.”
