UCSF doctors leading way on eliminating climate-harmful general anesthesia gas use
SAN FRANCISCO -- Doctors in San Francisco are at the forefront of a movement to replace the drugs used for general anesthesia, which have been determined to be contributing to our climate change crisis.
From hip replacements to C-sections and brain surgeries, modern medicine is simply not possible without anesthesia. More than 300 million major surgeries are performed every year around the world, with about 50 million in the U.S. alone.
One of those surgeries was performed on Rachel Hamid. Years ago when she was in college, Hamid went out for a run. A distracted driver plowed into her, throwing her up onto his windshield, and seriously injuring the young woman.
Hamid needed multiple surgeries to repair her severely damaged leg, requiring general anesthesia. She can't imagine not having these medicines.
"Oh my gosh, absolutely necessary," she said. "Any surgery without anesthesia would be cruel and unusual punishment."
The gas uned in general anesthesia knocks you out. You're not aware of the surgery. You also don't move or feel pain. But anesthesia that is inhaled presents an unsettling dilemma on this warming planet. These medicines are potent greenhouse gases, according to evidence gathered by the National Institutes of Health and the British Medical Journal.
One gas in question is desflurane. Desflurane is 2,540 times more potent as a greenhouse gas than carbon dioxide. Another problematic gas is nitrous oxide. Nitrous oxide is 274 times more potent a greenhouse gas than carbon dioxide and remains in the atmosphere for 114 years.
When it comes to most of the inhaled anesthesia, patients metabolize less than 5% of what they inhale. The rest is vented out of the operating room and then into the atmosphere.
"I took the Hippocratic Oath which said, 'Do no harm.' And some of the very choices in our practices are contributing to emissions - climate change - that is affecting the very patients we swore to take care of," declared UCSF anesthesiologist and Medical Director of Sustainability Dr. Seema Gandhi.
Gandhi, along with her colleague Kaiyi Wang, a sustainability analyst with UCSF, are part of a pioneering team at the forefront of a healthcare revolution. The goal: to reduce the use of potent greenhouse gases in the medical center and its operating rooms, but with no impact on the patient.
"There are newer drugs, there are newer technologies, newer ways of delivering the same quality of care," said Gandhi.
They took CBS News San Francisco on an exclusive tour of a highly-restricted area: the massive surgical unit at UCSF Medical Center Mt. Zion. First stop: Operating Room #10. Gandhi walked toward the back and then pointed up to the ceiling to a panel of outlets. Different colored hoses were hung from the panel; each connected to a colored-coded outlet. The hoses were all connected to hidden pipe systems buried within the walls.
But one hose - the blue one - was no longer there, and the outlet was covered. That blue hose supplied nitrous oxide to the operating room. In a five-year study, UCSF researchers discovered only a little bit of the pressurized nitrous oxide gas ever reached the operating room.
Gandhi said that the gas leaks from its large storage canisters in the basement or outside the hospital. The nitrous oxide also leaks as it travels through its designated pipe system in the walls.
"About 80 to 90 percent of the purchased nitrous oxide never made it to clinical care delivery," said Gandhi.
To mitigate the waste of a known greenhouse gas, UCSF has decided to stop using it thru the piped-in system.
Outside in the hall, next to Operating Room #11, the valve for the pipe system is shut off and removed.
"Which means we would no longer pipe nitrous oxide for the operating room, and we would be transitioning to portable e-cylinders," noted Wang.
The portable e-cylinders will continue to deliver nitrous oxide for labor and delivery, neurosurgery, and pediatric cases. All UC Medical Centers are following in UCSF's footsteps. And the new hospital that's being built at Parnassus Heights won't even have a nitrous oxide pipe system.
As for desflurane, UCSF Medical Center has essentially eliminated its use. Gandhi said that removing desflurane is like taking 240 gas-guzzling cars off the streets of San Francisco every year. Two months ago, Scotland became the first nation to ban desflurane and the E.U. plans on eliminating its use in all but the most exceptional cases.
What's also notable is that the American Society of Anesthesiologists has put out new guidance for its members, urging medical centers to take action to mitigate greenhouse gas emissions from inhaled anesthetics, in particular desflurane and nitrous oxide.
UCSF's early action has impressed Hamid. She thinks it is a great idea to rethink anesthesia on a warming planet.
"If San Francisco was starting this. I hope other cities can do the same." said Hamid.
That strategy may have us all breathing a little easier, on the path forward.