Hospitals can sharply reduce the climate impact and cost of surgery without compromising patient safety by changing routine anesthesia practices, including reducing the use of high-emission anesthetic gases, suggests a new study presented at the ANESTHESIOLOGY® 2026 annual meeting.
Healthcare is a major contributor to greenhouse gas emissions, and operating rooms are among the most resource-intensive areas of hospitals. Some inhaled anesthetic gases, particularly desflurane and nitrous oxide, are potent greenhouse gases that trap heat in the atmosphere and may contribute to climate change and the carbon footprint of operating rooms.
Our findings show that hospitals can take meaningful steps to reduce the environmental impact of surgery without compromising safety or quality. By making practical changes in anesthetic selection, reducing waste and giving anesthesiologists clear feedback, we reduced emissions and costs while maintaining strong patient outcomes."
Etta Hanlon, M.S., lead study author and researcher, Virginia Tech Carilion School of Medicine, Roanoke
The findings suggest that greener anesthesia does not require costly technology. The six-site academic health system encouraged greater use of sevoflurane and intravenous anesthesia, reduced fresh gas flow rates to minimize waste and provided anesthesiologists with feedback on their emissions. Neil Macdonald, M.D., chair of the Department of Anesthesiology at Carilion Clinic and associate professor at the Virginia Tech Carilion School of Medicine, Roanoke, helped establish the clinician feedback effort, including individualized emissions reports to support informed clinical decision making.
Researchers compared anesthetic use, estimated emissions, costs and patient outcomes in 2021 with results from January 2022 through October 2025, after the health system began implementing the changes. The study included 145,917 anesthetic episodes.
Average total emissions dropped from 57.6 kilograms of carbon dioxide equivalent (kgCO2e), a standard measure of climate impact, per anesthetic episode in 2021 to 31.6 kilograms after the intervention, a 45% reduction. Desflurane use also fell sharply, from 23.8% to 9.81% of cases, while sevoflurane use increased from 82.4% to 93.1%. By late 2025, the health system surpassed its goal of reducing emissions by 50%. Spending on inhaled anesthetics fell from $628,588 in 2021 to $379,010 in 2024, nearly 40% savings.
Importantly, the researchers found patients continued to recover from surgery safely, with no increase in recovery room stays, hospital stays, breathing tube reinsertion, awareness or postoperative nausea and vomiting after the changes were implemented.
"Patients shouldn't have to choose between environmentally responsible healthcare and safe, high-quality care," said Sara Wohlford, director of sustainability at Carilion Clinic. "These are changes health systems and clinicians can make behind the scenes, allowing patients to benefit from more sustainable care without having to do anything differently."
Improving healthcare sustainability through carbon data