Reducing desflurane use at Airedale General Hospital

As CT1 at Airedale General hospital I was new to anaesthesia. I was just getting to grips with the basics but one thing stood out to me – as a department a lot of people were using desflurane on a regular basis and it wasn’t really clear to me why. With the help of a consultant with a keen interest in sustainable anaesthesia and some helpful department pharmacists I started to look into it.

We collected data (using the Define database) looking at the purchasing of desflurane over the period of December 2017 and November 2018. Over 28% of the anaesthetic gas used by volume (ml) was desflurane. This was much higher than other hospitals in the region. This equated to almost 250000kg CO2 equivalent over one year at a monetary cost of £23383.

I presented these findings at the departmental audit meeting - putting the values in context with everyday equivalents such as miles driven, commercial flights, home energy used and eating meat. The values were received with shock amongst most of the department.

We then explored reasons for using desflurane, and with the help of some data from big studies, dispelled some myths. The final point of the session was to come up with some suggestions for action points which included: reducing desflurane use, using low flow anaesthesia (helped by the purchase of new anaesthetic machines) and using TIVA or regional anaesthesia where possible.

We returned to look at the data over the following year (December 2018 to November 2019). The results were impressive! Over that time period we:

  • Reduced desflurane use from a total of 28% to 14% of total anaesthetic vapour use (per ml)

This equated to:

  • a reduction in desflurane (ml) use by 58.5%
  • a reduction of 38880kg CO2 equivalent
  • a reduction in cost of £13,491
    • (once the relative increase in sevoflurane was added this reduction was still £12364)

The findings are something to be proud of and a good example of the difference education can make in changing attitudes and practices within a small department.

However, there is still a long way to go! This is just one step towards the bigger picture of becoming a more sustainable department and profession. This work is ongoing – check back for updates.

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