In December 2024, Newfoundland and Labrador became the first province in Canada to officially discontinue the purchase of desflurane and move to more environmentally sustainable alternatives. This is thanks, in large part, to the work of Quality of Care Newfoundland and Labrador (Quality of Care NL) and their Implementation Lead, Krista Mahoney.

Desflurane is one of the most common anesthetic gases and has been used in surgical procedures around the world for decades. It is completely safe for patients, but in recent years research has shown that it contributes heavily to rising global temperatures. It is approximately 2500 times more warming than carbon dioxide (CO₂₎ and has the highest global warming potential of all inhaled anesthetics. Not only is desflurane environmentally harmful, but it does not offer any appreciable clinical benefit over other anesthetic gases.

Quality of Care NL, a provincial initiative with a goal of using research and evaluation to improve social and health outcomes, has made climate action an important focus of its work. In 2023, an environmental sustainability team was created to investigate easily implementable climate initiatives. This research identified desflurane use as a possible target. Purchasing rates had already been declining steadily in NL and across Canada, due to clinician awareness of the environmental harms. In discussions, many clinicians cited the Canadian Anesthesiologist’s Society (CAS) guidelines and Choosing Wisely Canada recommendations, which demonstrated that there was already significant interest in the idea. In fact, organizations across the globe, including the UK’s National Health Service (NHS) have already begun discontinuing desflurane use in their systems, with Scotland and England being the first countries to ban it entirely.

“Awareness among the anesthesiology community wasn’t an issue,” said Mahoney. “Our main barrier was figuring out how to implement the change.”

Their solution was to host an in-person provincial meeting, which brought together leaders from all five health zones in NL. It was at this meeting that they collectively decided to take provincial action, as opposed to ending use at each of the province’s 12 hospitals individually. According to Mahoney, this was a key advantage that NL had when collaborating with the government and enacting these changes. In 2023, the province merged a number of individual health organizations into one health authority. The consolidated structure allowed these changes to take place all at once, rather than engaging with multiple groups on the same action item.

“This was a relatively quick and easy win,” said Mahoney, who has been a part of similar initiatives that can often take years to accomplish. The international consensus on desflurane allowed them to implement these changes with little to no pushback.

Across Canada, the Northwest Territories and Nunavut have also discontinued desflurane use in their health systems. The hope is that this list continues to grow, as other regions apply lessons learned from these early successes to implement similar changes. One such lesson is to use the backing of the Canadian Anesthesiologists’ Society and Choosing Wisely Canada’s climate-conscious recommendations to give weight to the argument. NL drafted a joint statement from chiefs of anesthesiology from all five zones which quoted guidelines from both organizations.

Quality of Care NL is now working towards addressing the administration of another potent greenhouse gas used in anesthesia, Nitrous Oxide.  They plan to decommission notoriously leaky piped systems in the walls and ceilings of most modern hospitals. It has been demonstrated that more than 90 per cent of gas is wasted due to leaks prior to reaching the patient. Additionally, they are continuing deprescribing efforts and hoping to collaborate with local Indigenous communities, to learn about and share their thoughts on land and environmental protection.

Desflurane is only the beginning of a much larger goal to change health care and reduce our carbon footprint. The success of this project demonstrates that change is not only possible, but there is still more work to be done.