Should inhalation anesthetics with large global warming potentials be banned?

Climate change is one of the most important environmental challenges of our time. Many anesthesiologists believe that inhalation anesthetics such as desflurane with its large global warming potential is a principal environmental problem of their profession and feel it is a moral imperative to eliminate its use from their own practices and to advocate for its universal prohibition. Others argue that clinical autonomy should be preserved whenever possible. Calculations based on widely accepted principles of atmospheric science present a possible resolution to this controversy. Even if desflurane were used for all of the more than 313 million surgical procedures performed each year and into the indefinite future, its effect on climate would be lost in the natural variation of global average temperature. Moreover, cessation of utilization would result in the rapid reversal of desflurane’s effects.

Climate change; Global warming; Global warming potential; Anesthetics; Desflurane

[1] Charlesworth M, Laycock H. Driving down the carbon cost of peri-operative care: old controversies, new topics, fresh perspectives and the future. Anaesthesia. 2024; 79: 223–225.

[2] Biro P. Calculation of volatile anaesthetics consumption from agent concentration and fresh gas flow. Acta Anaesthesiologica Scandinavica. 2014; 58: 968–972.

[3] Talbot A, Holländer HC, Bentzer P. Greenhouse gas impact from medical emissions of halogenated anaesthetic agents: a sales-based estimate. The Lancet Planetary Health. 2025; 9: e227–e235.

[4] Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bulletin of the World Health Organization. 2016; 94: 201–209F.

[5] Liu FL, Cherng YG, Chen SY, Su YH, Huang SY, Lo PH, et al. Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials. Canadian Journal of Anesthesiology. 2015; 62: 907–917.

[6] Kranke P, Jakobsson J, Marin L, Kleinberg R, Landoni G, Reinoso-Barbero F, et al. Protecting clinician autonomy and patient safety within the climate debate: the case for desflurane in modern anaesthesia. Current Opinion in Anesthesiology 2025 in press.

[7] Lloyd P, Fowler AJ, Wozniak A, Rattenberry W, Scott S, Tripurneni V, et al. Environmental impact of commonly used anaesthetic agents: systematic literature review with narrative synthesis. BJA Open. 2025; 13: 100362.

[8] Kampman JM, Hermanides J, Hollmann MW, Gilhuis CN, Bloem WA, Schraag S, et al. Mortality and morbidity after total intravenous anaesthesia versus inhalational anaesthesia: a systematic review and meta-analysis. eClinicalMedicine. 2024; 72: 102636.

[9] Vereecke H, Hasselager R. In 10 years will we need volatile anaesthetics? Let’s get rid of them now! Pro-con debate. 2025. Available at: https://euroanaesthesia.org/2025/wp-content/uploads/sites/4/2025/04/EA25_Therapies-programme_29.04-1.pdf (Accessed: 21 August 2025).

[10] Watts N, Moonesinghe R, Foreman C. Putting anaesthetic emissions to bed: commitment on desflurane, NHS England. 2023. Available at: https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed/ (Accessed:21 August 2025).

[11] Mathur S, Menikefs P, Rao A. Reducing/eliminating desflurane. 2025. Available at: https://ontariosanesthesiologists.ca/reducing-eliminating-desflurane (Accessed: 21 August 2025).

[12] European Union. REGULATION (EU) 2024/573 of the European parliament and of the council. 2024. Available at: https://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=OJ:L_202400573 (Accessed: 21 August 2025).

[13] Cain M, Lynch J, Allen MR, Fuglestvedt JS, Frame DJ, Macey AH. Improved calculation of warming-equivalent emissions for short-lived climate pollutants. Climate and Atmospheric Science. 2019; 2: 29.

[14] Fuglestvedt JS, Berntsen TK, Godal O, Skodvin T. Climate implications of GWP-based reductions in greenhouse gas emissions. Geophysical Research Letters. 2000; 27: 409–412.

[15] Pierrehumbert R. Short-lived climate pollution. Annual Review of Earth and Planetary Sciences. 2014; 42: 341–379.

[16] Slingo JM, Slingo, ME. The science of climate change and the effect of anaesthetic gas emissions. Anaesthesia. 2024; 79: 252–260.

[17] United Nations Framework Convention on Climate Change. Paris agreement. 2015. Available at: https://unfccc.int/documents/37107 (Accessed: 21 August 2025).

[18] Shine KP. The global warming potential—the need for an interdisciplinary retrial. Climatic Change. 2009; 96: 467–472.

[19] Shindell DT, Fuglestvedt JS, Collins WJ. The social cost of methane: theory and applications. Faraday Discussions. 2017; 200: 429–451.

[20] Kaufhold C, Willeit M, Liu B, Ganopolski A. Assessing the lifetime of anthropogenic CO2 and its sensitivity to different carbon cycle processes. Biogeosciences. 2025; 22: 2767–2801.

[21] Marin L, Kleinberg RL. Climate change, emissions of volatile anesthetics, and policy making: the case of desflurane. Anesthesia & Analgesia. 2025; 141: 123–127.

[22] Intergovernmental Panel on Climate Change. Climate Change 2021: the physical science basis. 2021. Available at: https://www.ipcc.ch/report/ar6/wg1/ (Accessed 21 August 2025).

[23] Shine KP. Climate effect of inhaled anaesthetics. British Journal of Anaesthesia. 2010; 105: 731–733.