da Silva Leopoldo Muniz, de Araújo Ana Claudia L F, Defácio Leandro, Vale Roberta B P, Machado Desiree S, Silveira Saullo Q, Nersessian Rafael S F, de Souza Neto Manoel, Mizubuti Glenio B, de Oliveira Lima Helidea
Rede D'Or, D'Or Institute for Research and Education (IDOR), São Paulo, SP, Brazil.
São Luiz Itaim Hospital/Rede D'Or, São Paulo, SP, Brazil.
Can J Anaesth. 2025 Jul 7. doi: 10.1007/s12630-025-03002-5.
Climate change is increasingly recognized as an emergency, particularly within the health care sector. Reducing nitrous oxide (NO) usage is critical for mitigating anesthesia-related greenhouse gas emissions, a significant environmental threat. We aimed to evaluate the effectiveness of implementing quality improvement (QI) strategies to reduce the carbon footprint in anesthesia practice at two quaternary hospitals in São Paulo, Brazil, São Luiz Anália Franco Hospital and and São Luiz Itaim Hospital. We aimed to lower NO use in inhalational anesthesia, targeting a 75% reduction in carbon footprint over 16 weeks.
Through a QI initiative, we restricted NO usage to inhalational induction in pediatric anesthesia only. Employing quality and safety tools, we implemented educational strategies to limit NO application and minimize waste from the central anesthesia workstation pipeline. We calculated greenhouse gas emissions as carbon dioxide equivalents (COe), monitored adverse events, and tracked sedative agents use both before and after the interventions.
From January to August 2024, our project encompassed 30,217 anesthetics over 32 weeks. Among these, 6,806 involved inhalational anesthesia, with 624 (9%) involving NO. In adult patients, baseline data over 16 weeks prior to the intervention showed an average NO usage rate of 11%, which decreased significantly to 2% postintervention (P < 0.001). In pediatric patients, NO usage dropped from 62% to 46% following the intervention (P < 0.001). The emissions per anesthetic using NO declined from 132 kg (lower control limit [LCL], 98 kg; upper control limit [UCL], 167 kg) to 23 kg (LCL, 9 kg; UCL, 38 kg) following our interventions.
By optimizing NO usage through educational and judicious interventions, our QI initiative achieved a 82.5% postintervention reduction in anesthesia-related institutional COe. Moreover, we fostered a significant cultural shift, enhancing accountability for health care initiatives aimed at environmental protection.
气候变化日益被视为一种紧急情况，尤其是在医疗保健领域。减少一氧化二氮（N₂O）的使用对于减轻与麻醉相关的温室气体排放至关重要，这是一个重大的环境威胁。我们旨在评估在巴西圣保罗的两家四级医院——圣路易斯·阿纳利亚·佛朗哥医院和圣路易斯·伊塔伊姆医院实施质量改进（QI）策略以减少麻醉实践中的碳足迹的有效性。我们旨在降低吸入麻醉中N₂O的使用，目标是在16周内将碳足迹减少75%。
通过一项QI倡议，我们将N₂O的使用仅限于小儿麻醉的吸入诱导。我们运用质量和安全工具，实施教育策略以限制N₂O的应用，并尽量减少中央麻醉工作站管道中的浪费。我们将温室气体排放计算为二氧化碳当量（CO₂e），监测不良事件，并跟踪干预前后镇静剂的使用情况。
2024年1月至8月，我们的项目在32周内涵盖了30217例麻醉。其中，6806例涉及吸入麻醉，624例（9%）涉及N₂O。在成年患者中，干预前16周的基线数据显示N₂O平均使用率为11%，干预后显著降至2%（P＜0.001）。在小儿患者中，干预后N₂O使用率从62%降至46%（P＜0.001）。我们的干预措施实施后，使用N₂O的每例麻醉的排放量从132千克（下限控制限[LCL]，98千克；上限控制限[UCL]，167千克）降至23千克（LCL，9千克；UCL，38千克）。
通过教育和明智的干预措施优化N₂O的使用，我们的QI倡议在干预后使与麻醉相关的机构CO₂e减少了82.5%。此外，我们促成了重大的文化转变，增强了对旨在环境保护的医疗保健倡议的责任感。
