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Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 8 - No.8 2020 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 25

Reducing the Carbon Footprint of the Anesthesia Provider
Levi Scott McGowan, DNP, CRNA

KEYWORDS:  Carbon Footprint, Anesthesia, Greenhouse Gases, Global Warming

Abstract
Modern anesthesia contributes to environmental pollution with some anesthetics creating a larger carbon footprint. 
Certified Registered Nurse Anesthetists (CRNA) provided over 45 million anesthetics in 2018, and practice changes 
could dramatically reduce the carbon footprint.  The purpose of this quality improvement project was to provide 
education to a convenience sample of 10 CRNAs about concrete measures which reduce the carbon footprint of 
anesthesia care and provide multiple secondary benefits. Results showed that when given additional education about 
environmentally cleaner anesthetics, the clinicians became more aware of safer and greener alternatives for anesthetic 
use.  The reduced carbon footprint anesthetic is not only better environmentally but is also safer and leads to improved 
patient satisfaction by reducing postoperative nausea and vomiting.  

AEJ



Educated Hand Publishing LLC 
“The Science Behind the Art” 
Volume 8 - No.8 2020 

 Anesthesia eJournal - Online
ISSN 2333-2611

Page 26

References

Reducing the Carbon Footprint of the 
Anesthesia Provider

Levi Scott McGowan, DNP, CRNA

● To  provide awareness in the form of continuing education 
regarding anesthesia practices that are more environmentally 
friendly and reduce the carbon footprint utilizing a convenience 
sample of 12 Certified Registered Nurse Anesthetists (CRNAs).  

1. National Academy of Sciences (U.S.), Royal Society (Great Britain). Climate Change : Evidence & Causes. Washington D.C.: National 

Research Council; 2014.Accessed June 1, 2020.  http://www.nap.edu/catalog.php?record_id=18730.

2. Campbell M, Pierce JMT. Atmospheric science, anaesthesia, and the environment. BJA Education. 2015;15(4):173-179. 

doi:10.1093/bjaceaccp/mku033.
3. Sherman J, Le C, Lamers V, Eckelman M. Life cycle greenhouse gas emissions of anesthetic drugs. Anesthesia and Analgesia. 

2012;114(5):1086-1090. doi:10.1213/ANE.0b013e31824f6940.

4. Lipana L, Credaroli E., Sukumar M, Dai F, Sherman J.  Surveying knowledge on environmental impact of anesthetic gases using an 
original mobile application.  Lecture presented at: Anesthesiology; June 2017 Session; Boston, MA.

5. Hall MJ, National Center for Health Statistics (U.S.). Ambulatory surgery data from hospitals and ambulatory surgery centers: United 
States, 2010. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National 

Center for Health Statistics

6. Zuegge L. Ecological and economical practice for anesthesiologists.  Advances in Anesthesia. 2013;31(1): 21-29.

7. Gan TJ, Diemunsch P, Habib AS, et al. Consensus guidelines for the management of postoperative nausea and vomiting. Anesth Analg. 

2014;118(1):85-113.

● Data shows world surface temperatures have increased by 
0.8ºC (1.4 ºF) since 1900. Humans have accelerated the  
release of large amounts of greenhouse gases into the 
atmosphere since the industrial revolution.  The atmospheric 
concentrations of CO2 has increased by 40% with most 
accumulation of greenhouse gases occurring after 1970.¹ 

● The United States (US) healthcare industry accounts for over 
8% of total carbon dioxide emissions.³  

● Anesthesia contributes to about 5% percent of the total carbon 
emissions in healthcare. It has been estimated that the annual 
effect of all inhalation agents is the equivalent to one coal fired 
power plant.²

● .  According to the CDC in 2010, 48.3 million hospital-based 
surgical and nonsurgical procedures performed in the US 
contributed to global warming.⁵

● A Yale Study conducted in 2017 concluded there are gaps in 
knowledge related to the environmental impact of anesthetic 
practice.⁴  

• Design: Quality improvement project using an educational 
session to increase awareness on methods to reduce the 
carbon footprint of anesthesia   

• Setting: Community hospital in southeast region of the US

• Sample population: Convenience sample of 12 practicing 
CRNAs with an average of xx years of experience

• Data collection: Post education survey data collected in 
June 2019 

• Measurements: Likert and multiple-choice survey 
assessed educational sessions’ effectiveness and post-
session knowledge 

• Quantitative analysis of survey was performed.

RESULTS
● 40% (N=10) of participants reported no prior knowledge of 

anesthesia-related carbon footprint reduction education.

● Attendees gained knowledge and selected the correct answers 
at a statistically significant rate with p values < 0.05 for single 
correct answer questions.  

● Climate change opinions of the participants did not statistically 
change the post educational survey Likert questions on carbon 
footprint reduction based of the Mann Whitney U test of less 
than two for statistical noteworthiness. 

● According to the post educational survey, 100% of participants 
agreed Carbon Footprint and Anesthesia selection should be 
incorporated into future SRNA curriculum 

● Curriculum development is needed to educate current and future anesthesia 
providers about the benefits of greener anesthesia techniques.

● Limiting desflurane use can reduce pharmacy costs and lower the environmental 
impact. 

● Generic propofol has one of the lowest costs and lowest carbon footprints.
● Propofol has secondary benefits such as a 25% reduction in PONV which can 

reduce patient-related stress and overall healthcare costs.⁷
● A lower carbon footprint anesthetic can lower pharmacy costs, improve patient 

satisfaction and reduce anesthetic-related PONV.   

Anesthesia Agent & Carbon Footprint Impact

PURPOSE

CONCLUSIONS

METHODS

BACKGROUND & 
RESEARCH

$

● Modern-day anesthesia has a variable impact on 
the environment based off the selected anesthetic.

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