Putting anaesthetic emissions to bed: commitment on desflurane

Since its introduction in 1846, anaesthesia has saved countless lives. It has enabled the safe and humanitarian delivery of procedures and operations that simply could not have happened otherwise.

Today, anaesthetists provide general, regional and local anaesthesia, as well as lead preparation for and recovery from surgery. They provide support for women and babies around the time of childbirth, help with the management of acute and chronic pain, and offer lifesaving support for the most unwell emergency patients both inside and outside hospitals.

Anaesthetics – and anaesthetists – are here to stay. But the specialty faces another health challenge: the climate crisis.

Anaesthetic and analgesic practices account for 2% of the NHS carbon footprint. If the NHS is to deliver on its world-first net zero ambition – and play its crucial part in reducing the health impacts of climate change – it must address emissions associated with this specialty.

Desflurane, a volatile anaesthetic used for surgery, is a good place to start. It’s one option used by anaesthetists to put patients to sleep safely, but it has a global warming potential 2,500 times greater than carbon dioxide.

The good news is that safe and appropriate alternatives with a significantly lower global warming potential exist. These include alternative general anaesthetic gases, and alternative anaesthetic techniques including regional anaesthesia.

That’s why, with the support of the Royal College of Anaesthetists and the Association of Anaesthetists, NHS England has announced the decommissioning of desflurane by early 2024.

Stopping the use of desflurane across the NHS, with use allowed only in exceptional clinical circumstances, will further reduce harmful emissions by around 40 kilotonnes of carbon a year – the same as powering 11,000 homes every year.

Over the course of a decade, emissions saved through the elimination of desflurane would be equivalent to those that result from powering every home in Plymouth for a year.

This announcement is significant and sends a strong signal to the clinical community that the NHS in on the road to delivering a net zero health service.

But it is by no means the start of the journey.

Alert to its environmental harms, clinicians up and down the country have commenced a sustained move away from desflurane and have been opting to use clinically appropriate and safe alternatives.

Over 40 trusts in England have now stopped using the environmentally harmful gas altogether – with trusts like Norfolk and Norwich, Bristol and Weston, and Torbay and South Devon leading the way. The use of desflurane across the NHS has fallen from 20% of all anaesthetic gases used, to just 3%, over the last 4-5 years.

Anaesthetists have been saving lives for more than a century. They have the chance to save even more in the future.

Thanks to the efforts of NHS staff up and down the country, along with the support of the Royal College of Anaesthetists and the Association of Anaesthetists, we can and will put anaesthetic emissions to bed. For the benefit of patients and the planet.

Dr Matthew Davies, President of the Association of Anaesthetists, said:

“If we are serious about combatting the catastrophic effects of climate change, we must reduce those emissions associated with medical gases when we have clinically suitable alternatives already available.

The decommissioning of desflurane is a crucial step in limiting the environmental impacts of surgery, which is why the Association of Anaesthetists are proud to announce on behalf of our members that, alongside NHS England and the Royal College of Anaesthetists, we have committed to stop the use of this environmentally harmful anaesthetic by 2024.

This is a hugely significant achievement which would not have been possible without the support of our members who are working incredibly hard to deliver a greener health service by moving away from the routine use of desflurane.”

Dr Helgi Johannsson, Vice President of the Royal College of Anaesthetists, said:

“The Royal College of Anaesthetists are proud to partner with NHS England on the commitment to stop using desflurane in routine practice by early 2024.

Anaesthetists are in the privileged position to be able to influence greatly the NHS’s carbon footprint, and we have already reduced the use of desflurane enormously, with many hospitals now not using it at all. We will be actively supporting our members to cease routine use of desflurane and highlighting the safe and effective alternatives.

This is a significant step in the right direction, but there is a lot more to do, and we are determined to do what we can to reach net zero, and reduce the potentially catastrophic impact of climate change.”

Read the joint statement from NHSE, the Royal College of Anaesthetists and the Association of Anaesthetists on the decommissioning of desflurane by early 2024.


Claire Foreman, Director of Medicines Policy & Strategy, NHS England and Improvement

Claire has worked in the NHS for over 20 years, leading work to improve patient access, experience and outcomes in care and treatments. Over the last decade, Claire has focused on developing medicines policy and strategy in specialised commissioning in regional and national roles. Claire joined the Commercial Medicines Directorate in the summer of 2021 to lead our policy, strategy and analysis work, helping drive our efforts on medicines access including innovative treatments, on optimisation and value programmes, and on medicines sustainability and Net Zero. Claire is passionate about the role of medicines in improving patient outcomes and reducing health inequalities and has a particular interest in innovative medicines.


Professor Ramani MoonesingheProfessor Ramani Moonesinghe, National clinical director for critical and peri-operative care

Professor Ramani Moonesinghe is Professor of peri-operative medicine at University College London. She trained in medicine, anaesthesia and critical care in London and works clinically at University College Hospital. She is Director of the national Health Services Research Centre at the Royal College of Anaesthetists and head of her research department at UCL; her research focuses on health services research, improvement based research and clinical trials in perioperative and critical care in the UK and overseas.


Dr Nick WattsDr Nick Watts

Dr Nick Watts is the Chief Sustainability Officer of the NHS, responsible for its commitment to deliver a world-class net zero emission health service. Based in London, he leads the Greener NHS team across the country, which focuses on improving the health of patients and the public through a robust and accelerated response to climate change and the broader sustainability agenda.

Nick is a medical doctor licensed in Australia and the UK, and has trained population health and public policy. He is a Member by Distinction of the Royal College of Physicians’ Faculty of Public Health, and an Honorary Associate Professor of University College London’s Institute for Global Health.

Prior to the National Health Service, Nick worked internationally as the Executive Director of the Lancet Countdown and the Lancet Commission on Health and Climate Change, a collaboration of UN agencies and academic centres across the world. He has also focused on engaging the health profession on the links between public health and climate change, having founded both the Global Climate and Health Alliance and the UK Health Alliance on Climate Change.