In some respects it seems like this battle has been won. For no clinical penalty with a financial benefit, we’ve made significant reductions in carbon emissions by switching anaesthetic agents. Desflurane is being removed from the NHS, most Western Australian public hospitals have already removed dirtydes from their hospitals and many have followed suit on the east coast of Australia.
If your institution is still using or stocking desflurane, read on for resources which may help you.
One of the best resources is TRA2SH’s Refuse Desflurane campaign.
GTN legends Dr Laura Wisniewski and Dr Chris Mitchell have put together this excellent article published in ANZCA Bulletin Autumn 2022 which recounts the Western Australian story for ditching desflurane, including lessons learnt
The lessons learned from WA’s remarkable reduction in desflurane use can be distilled into the following
1. Measure the current volatile and propofol use in your department as a baseline. Start a simple database to track your department’s progress. This is easy to do using pharmacy purchase data as it bypasses the complexity of determining individual theatre usage (and pharmacy sta are generally keen to help when they are presented with the potential “financial savings”.
2. It is critical to raise awareness, empower and educate people who are willing to champion the cause in their department.
Most anaesthetists are willing to change their behaviour and
practice when presented with clear evidence and scientific
reasoning. Those who have had reservations regarding the
change have often been surprised to see that, in practice, their
concerns were unfounded. There are a number of existing
organisations (for example, TRA2SH )
which can assist in providing information and resources to
support the phasing out of desfurane.
3. Sequentially institute physical changes to reduce the usage
and availability of desflurane. For anaesthesia machines
with end tidal control, set a default low-fresh gas flow (for
example, 0.55l/min on the GE Aisys machine). After educating
the department and anaesthetic assistants, start storing the
desflurane cassette in the anaesthetic trolley (rather than
installing in the machine). This physical reminder to desflurane
users that the department was trying to decrease usage
assisted in a signifcant change. The next step is removing the
desflurane from theatre and storing it in theatre pharmacy. This
balance between availability, but inconveniently so, results
in many of the “devout” users exploring the acceptability of
alternative agents. The final step is to remove desflurane from
the hospital. This has occurred at different times in various
hospitals, depending on the leadership style of the head of
department. In some instances, it has been by simple autocratic
removal, in others, it was put to the consultant group vote.
4. Ongoing cycles of monitoring and education are vital in order
to enact the required change. In parallel, aim to gradually ramp-
up barriers to accessing des!urane. It must be recognised that
change will not be immediate. The Green Theatres Network,
as well as the TRA2SH group, have both been involved across
WA in raising awareness and providing ongoing education.