At Trillium Health Partners in Mississauga, the decision to stop using the common anesthetic gas desflurane during surgeries made a big difference. The hospital reduced carbon emissions from anesthetic gases by more than 90 per cent — going from 860 tonnes of CO2 per year to just 80.
Anita Rao, an anesthesiologist and the physician lead of environmental sustainability at Trillium, helped lead the change. She says switching to a cleaner alternative, sevoflurane — another commonly used anesthetic gas — not only reduced emissions but also saved the hospital up to $125,000 a year, even as the number of surgeries increased.
Trillium is one of more than 100 hospitals in Canada that have now eliminated desflurane. Rao is part of a growing coalition of doctors, nurses and hospital leaders advocating for its phase-out in favour of better alternatives and a broader push for a more sustainable healthcare system across the country.
She said the urgency to decarbonize healthcare comes from the growing health impacts of climate change. While treating patients, the system also creates pollution and waste that, over time, is making people sicker. “Out of all industries, I believe we have the greatest responsibility and should be the most accountable to our communities. That means we should take the lead in decarbonizing,” Rao said.
What is desflurane, and why is it a problem?
Desflurane is a gas used to keep patients asleep during surgery. It’s delivered through a breathing tube while the patient is unconscious. After the procedure, the gas is removed from the patient’s breathing system and the operating room using a vacuum system — but instead of being filtered, it’s released directly into the atmosphere, much like smoke from a factory.
“Think of it like a coal plant, or a steel plant in Hamilton, releasing emissions through a chimney,” Rao said. “That’s kind of what happens in the hospital — these gases are released unfiltered into the atmosphere.”
Desflurane belongs to a group of heat-trapping gases called hydrofluorocarbons (HFCs), a human-made chemical which contributes significantly to global warming. It stays in the atmosphere for about 14 years — compared to under a year and a half for sevoflurane, a commonly used alternative — and is 40 to 50 times worse for the environment.
In terms of climate impact, using desflurane for one hour creates as much carbon pollution as driving a car 320 kilometres. That’s why many hospitals are switching to sevoflurane — it’s cheaper, works just as well, and pollutes far less, Rao said.
Canada has signed the COP26-WHO Declaration to build low-carbon, climate-resilient health systems, but the coalition says funding and action have been slow to follow. Meanwhile, other countries are moving faster. The United Kingdom has already banned desflurane, and the European Union will by 2026.
The Northwest Territories and Newfoundland and Labrador were the first jurisdictions in Canada to fully ban desflurane.
The coalition is now calling on all provinces and territories, and the federal government, to follow their lead and implement a nationwide ban.
Healthcare’s bigger climate problem
Desflurane is just one part of a much larger issue. Canada’s healthcare sector emits more greenhouse gases than the aviation and shipping industries combined, yet it remains largely overlooked.
According to The Lancet, a medical journal, it accounts for up to five per cent of the country’s total emissions — one of the highest per capita rates in the world. Between 2018 and 2019, the sector’s emissions rose by 1.3 per cent, equal to adding nine million cars to the road.
Courtney Howard, an emergency physician at Stanton Hospital in Yellowknife and president of the Northwest Territories Medical Association, says climate change is already disrupting healthcare delivery. During the 2023 wildfires, her hospital had to evacuate along with the entire city — something she believes will happen more often in the future.
Howard, who also chairs the Global Climate and Health Alliance, warns that healthcare systems are vulnerable to the cascading effects of climate instability. Wildfires, floods, heatwaves and severe storms are already straining infrastructure, disrupting supply chains and affecting the health workforce.
“By phasing out desflurane, Canadian hospitals are leading by example in reducing the greenhouse gas emissions that are the greatest threat to health systems stability,” she said.
Tens of thousands of Canadians have already been displaced by wildfires, and millions are breathing smoke-filled air linked to asthma and heart disease. Howard says Canada must dramatically increase investment in its National Adaptation Strategy. But even with stronger preparation, she warns that health systems won’t be able to cope unless emissions are brought down.
Hospitals themselves contribute to the problem. Howard points to unnecessary tests, single-use plastic tools, and other wasteful practices that raise both emissions and costs. She says reducing this waste would benefit the environment and patient care. “What we really need is good care, not more care,” she said.
Howard and Rao say governments need to hire staff focused on climate and health, and medical schools must begin educating future healthcare professionals about the impacts of climate change.
Globally, healthcare is responsible for about 4.4 per cent of total carbon emissions — enough to rank as the fifth-largest emitter if it were a country. Experts estimate that about 70 per cent of those emissions come from the supply chain, including drug production, single-use plastics and equipment. The rest comes from buildings, transportation and travel.
If current trends continue, climate change could lead to 14.5 million additional deaths and $12.5 trillion in global economic losses by 2050. Costs to healthcare systems alone could rise by another $1.1 trillion.
Rao believes real change is possible in the system. “Personally, I don’t have much influence on the fossil fuel industry, but we’ve managed to cut thousands of tonnes of carbon emissions just by changing how we practise,” she said.
Abdul Matin Sarfraz / Canada’s National Observer / Local Journalism Initiative
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