Greener Anesthesia Emissions Cut 45 percent in US Hospitals

Hospitals can sharply cut the climate impact of surgery without compromising patient safety by changing routine anaesthesia practices, a new study presented at the ANESTHESIOLOGY 2026 annual meeting suggests. The six-site US health system cut greener anesthesia emissions by 45 percent per procedure while also lowering its drug spending.

Healthcare is a major contributor to greenhouse gas emissions, and operating rooms are among the most resource-intensive areas of hospitals. Some inhaled anaesthetic gases, particularly desflurane and nitrous oxide, are potent greenhouse gases that trap heat in the atmosphere and raise the carbon footprint of every operation.

How greener anesthesia emissions cuts were achieved

The health system encouraged greater use of sevoflurane and intravenous anaesthesia, cut back on desflurane, reduced fresh gas flow rates to minimise waste, and gave anaesthesiologists individualised feedback on their emissions. Etta Hanlon, the lead study author and a researcher at Virginia Tech Carilion School of Medicine in Roanoke, said the changes were deliberately practical rather than technological.

"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 anaesthetic selection, reducing waste and giving anaesthesiologists clear feedback, we reduced emissions and costs while maintaining strong patient outcomes," Hanlon said. Neil Macdonald, chair of the Department of Anesthesiology at Carilion Clinic, helped set up the clinician feedback effort, including tracking greener anesthesia emissions per case.

The numbers behind the change

Researchers compared anaesthetic use, estimated emissions, costs and patient outcomes in 2021 with results from January 2022 through October 2025, covering 145,917 anaesthetic episodes. Average total operating room emissions fell from 57.6 kilograms of carbon dioxide equivalent per episode in 2021 to 31.6 kilograms after the intervention — a 45 percent reduction. By late 2025 the system had surpassed its goal of cutting emissions by half.

Desflurane use fell sharply, from 23.8 percent to 9.81 percent of cases, while sevoflurane use rose from 82.4 percent to 93.1 percent. The shift mattered because the gas traps far more heat per dose than sevoflurane, so swapping one gas for another delivered most of the climate benefit with no new equipment.

Patient safety stayed strong

Crucially, patients continued to recover safely. The study found no increase in recovery room stays, hospital stays, breathing tube reinsertion, awareness during surgery, or postoperative nausea and vomiting after the changes were introduced. The results address the central worry about hospital sustainability measures: that greener care might mean worse care.

Greener anesthesia emissions cut costs too

Spending on inhaled anaesthetics fell from 628,588 dollars in 2021 to 379,010 dollars in 2024 — savings of nearly 40 percent. The greener anesthesia emissions programme therefore paid for itself, a point the authors expect will persuade budget-conscious hospital boards. Lower flows and cheaper gases cost less as well as polluting less.

"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."

Why greener anesthesia emissions matter globally

Operating room emissions are a large and growing slice of healthcare's carbon footprint worldwide, and anaesthetic gases are among the few sources hospitals can address immediately. The researchers argue that greener anesthesia emissions should become a standard quality metric, alongside safety and cost, because the interventions are cheap, fast and proven.

For hospitals considering a similar move, the study offers a blueprint: measure the gases, feed the numbers back to clinicians, favour lower-impact agents and keep a close eye on outcomes. The evidence now shows that greener anesthesia emissions need not come at the expense of the patient on the table — a win for hospital sustainability that other systems can copy.