The Alfred ditches desflurane

31 May 2021

The Alfred in Melbourne is the latest Australian hospital to stop using desflurane as an anaesthetic gas because of its greenhouse gas emissions.

Professor Paul Myles, Director of the Department of Anaesthesiology and Perioperative Medicine at The Alfred and Monash University says the recent decision to remove desflurane from the hospital’s formulary was overwhelmingly supported by the hospital’s anaesthetists and trainees.

“It has effectively been banned from use at the hospital,” Professor Myles confirmed.

“The move was discussed over the last few months and we came to a final decision two weeks ago. Not one person has raised a concern and there have been no complaints. We’ve had very strong positive feedback from all staff.

“The environmental impact of desflurane has been debated for quite a few years and I now think we’ve got to the point of being more environmentally conscious. Anaesthetists can do many things to help the environment and this can be anything from recycling and cutting down on our use of single use plastics and reducing our carbon emissions where possible. The stand out bad actor is desflurane.”

Professor Myles says the actual benefits of desflurane are small and can be readily replaced with other anaesthetic agents that are more environmentally friendly.

“As an alternative, sevoflurane has a negligible impact on greenhouse gases— and is by far leagues above any other anaesthetic gas.

“The decision makes a clear statement − it reflects the views of most of the anaesthetic department staff and it’s a reminder for our trainees to always consider cost-effective and safe techniques of which there are many that don’t rely on desflurane. It’s partly a moral stand because of the impact on greenhouse gas emissions but equally in terms of healthcare, good anaesthesia and patient safety it comes at no cost. It’s a reminder for everyone to reflect on the choices they make in their clinical practice.”

Western Health in Melbourne took a similar approach in 2018 by removing desflurane from its anaesthetic trolley, an environmental initiative led by anaesthetist and intensive care specialist Dr Forbes McGain. That move was recognised with a finalist nomination in the 2018 Victorian Premier’s Sustainability Awards Health category.

According to ANZCA’s PS64 Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice desflurane has “a high intrinsic environmental impact, at least ten-fold greater than sevoflurane and isoflurane.”

Global momentum is building against desflurane. The anaesthetic trainee group, TRA2SH, (Trainee-Led Research and Audit in Anaesthesia for Sustainability in Healthcare) is asking Australian and New Zealand anaesthetic departments to take the #ditchthedes pledge to be desflurane free by 2025.

Several hospitals have already taken the pledge including Fiona Stanley Hospital in Western Australia, the Royal Brisbane and Women’s Hospital, Auburn Hospital in NSW, Logan Hospital in Queensland and the South Metropolitan Health Service in Western Australia.

Professor Myles said he expected that within the next decade, or even earlier, desflurane will no longer be used in Australian hospitals.

Alfred anaesthesia trainee, provisional ANZCA fellow Dr Stewart Brown, said the hospital’s anaesthetists had worked closely with the department’s nursing staff to encourage sustainable healthcare practices which not only included banning the use of desflurane but limiting bluey use and single use plastic.

“This really is a step in the right direction for the department and the hospital and it’s something that everyone is motivated about. There is no need to continue using desflurane and the decision to remove it will not affect clinical practice.”

Last updated 11:24 31.05.2021