Desflurane: Banned for Bad Climate Behaviour
Desflurane: 1,2,2,2-tetrafluoroethyl difluoromethyl ether
Back in June of 2020, I sat under the gazebo in the backyard of Sudbury anesthetist-environmentalist Sanjiv Mathur, swatting at mosquitoes, and admiring his astroturf. It has definite environmental and lifestyle merits, I thought. No mowing, no watering, no weeds to dig up or kill . . . it even resembles grass, from a distance.
But grass, fake or otherwise, was not the topic on our agenda. I was there to discuss Mathur’s role in getting Health Sciences North Sudbury to eliminate the anesthetic gas Desflurane from its hospital formulary. In other words, get rid of it altogether. Banish it, for bad climate behaviour.
Desflurane, and its cousin Sevoflurane, are more properly called vapours. Both are breathed in through a mask along with air, oxygen, and/or nitrous oxide (N2O), and both quickly put their recipient to sleep.
I probably breathed in some gas myself a year ago for a hip replacement, and I can testify to the fact that no awareness, no pain, and no memory are really good things, when you’re having major surgery.
I don’t know if I was given Desflurane or Sevoflurane. It likely wouldn’t have made any difference to my experience. But the choice does matter to the planet’s health. Des and Sevo are both potent greenhouse gases. However, gram for gram, they are not equal. Sevoflurane is 130 times as bad as CO2. Desflurane is 2540 times as bad!
Having grown up with an IPCC scientist for a father, Mathur was aware of the implications of climate change from a young age.
And so it might seem ironic that he ended up in a specialty with a particularly high carbon footprint, spending his days putting patients to sleep with greenhouse gases,
Almost 100 percent of these gases are breathed back out unchanged, gathered up from the OR air, and dumped out into the atmosphere through the roofs of hospitals.
Mathur, and a good many other anesthetists these days, struggle with the contradiction. In their effort to provide health care for one specific patient, they cause harm to the planet’s climate and consequently to the health of all humans. It totally contradicts the best known ethical precept in medicine: first do no harm.
In 2017, Mathur attacked the Desflurane issue head-on with a series of studies. He started by comparing the carbon footprints of the two gases, according to 2016 purchasing records.
The difference was equivalent to driving to the moon and back five times in a typical passenger vehicle.
Then he and his colleagues looked at sixty-three instances of a specific surgical procedure over eighteen months. They showed that the carbon footprint of doing it with Desflurane was forty-three times as high as with Sevoflurane. And there was NO difference in outcomes.
Then he looked at the carbon footprints of individual anesthetists who use Desflurane, and determined that if they cut their usage in half, they could obliterate the carbon footprints of three to four typical Canadians each year.
After all that, he calculated that if a carbon tax were applied to these drugs, Desflurane would become so ridiculously expensive that no-one would ever use it again, which would be appropriate. It is that expensive. We’ve just been ignoring the environmental part of its cost, which we are all paying for every year in fires and floods and heat waves and rising oceans.
And finally, Sanjiv Mathur took all his data and calculations, and went on tour to a series of anesthesia conferences, to make the case for getting rid of this noxious vapour.
After all that, his colleagues in HSN’s Department of Anesthesia rewarded him by removing Desflurane from the hospital formulary. It will (hopefully) never be used in Sudbury again. And that is a victory few anesthetist-environmentalists have managed to achieve. Congratulations, Sanjiv Mathur.
