Reducing the Environmental Impact of Anesthetic Gases in England Without Worsening Clinical Outcomes for Patients or Increasing Resource Use

OBJECTIVES: Desflurane has a higher global warming potential than other general anaesthetic agents. NHS England (NHSE) aims to be carbon neutral by 2045, acknowledging the link between planetary and human health. In 2023, NHSE, the Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists (AoA) announced the decommissioning of desflurane for routine use. To inform the content of, and the need for any exceptions to, the decommissioning policy, NHSE commissioned NICE to review the evidence on the clinical and resource benefits of using desflurane compared with other general anaesthetic agents.

METHODS: The scope was set by NHSE, RCoA and AoA following extensive clinical expert engagement. People having neurological procedures, and people with a body mass index (BMI) of at least 30 kg/m² having any procedure, were identified as relevant populations. Systematic searches were conducted in 7 databases. Records were reviewed based on title and abstract, then in full text. All studies meeting the selection criteria were included. Results were summarised narratively and reviewed by specialist commentators (clinical experts, NHSE).

RESULTS: Seven randomised controlled trials were included: 5 for people having neurological procedures; 2 for people with high BMI having any procedure. A large retrospective cohort study was also included for the high BMI population. Study quality issues were identified in all but 2 studies. None of the studies indicated that desflurane is associated with improved clinical or resource outcomes compared with alternatives. Overall, the results did not favour one general anaesthetic over another.

CONCLUSIONS: No high-quality evidence was found to suggest that desflurane is associated with improved clinical or resource outcomes compared with other general anaesthetic agents in these populations. The findings have informed the content of NHSE's desflurane decommissioning policy. The study demonstrates how bodies like NICE can help ensure that patient outcomes are not compromised by the system’s environmental sustainability goals.