Anesthetic gases are an essential part of delivering high-quality health care, as they ensure that patients are unconscious, pain-free, and immobilized during surgery. They are also the largest single source of carbon emissions in health care settings. When released into the atmosphere, they act as greenhouse gases, contributing to global warming. This environmental impact is comparable to more well-known sources of carbon dioxide emissions, such as transportation and the burning of fossil fuels. 

A team of anesthesia clinicians at Massachusetts General Hospital are taking important steps to reduce this outsized environmental footprint without compromising the quality of patient care.

Two years ago, we began our efforts to educate our colleagues and raise awareness of the impact of anesthesia on the environment. Since then, the department has reduced its anesthesia-related carbon footprint by 75%.

Samuel Smith, MD, MPH
Sustainability Anesthesia Committee

Together, Samuel Smith, MD, MPH, and Lucinda Everett, MD work with the Mass General Center for the Environment and Health (CEH) as part of its Sustainability Anesthesia Committee. This committee comprises dedicated clinicians who are enthusiastic about identifying and putting into action hospital-wide initiatives. 

Since they began two years ago, they have helped the Department of Anesthesia, Critical Care and Pain Medicine significantly reduce the environmental impact of the anesthetic gases it uses. 

In this Q&A, Dr. Smith and Dr. Everett share more about the sustainability efforts they are leading at Mass General, which champion both the well-being of patients and the well-being of the planet. 

Q. Why did you decide to launch the Sustainability Anesthesia Committee?

Dr. Smith: When I first joined Mass General as an attending, there was already a lot of talk happening about sustainability and pursuing “greener practice” approaches. When the CEH was newly formed, Jonathan Slutzman, MD, the director, contacted me, as he knew that I was interested in sustainability and actively training residents in greener practices in the operating room. We worked together to form a committee specific to anesthesia sustainability.  

Q. What is the committee focused on addressing?

Dr. Samuel Smith
Samuel Smith, MD, MPH

Dr. Smith: It is extremely important that, as clinicians, we reduce the carbon footprint associated with our anesthetic choices and waste. Our goal is to create as environmentally conscious an anesthesia practice as possible, and find approaches that benefit both the patient and the environment. We started with looking at ways to reduce the amount of gas we use for each patient (in line with national guidance) and choose anesthetics that have an optimal patient profile, but also minimize environmental harm. We also work to educate our team and our colleagues on the environmental impact of anesthesia. 

Dr. Everett: We receive monthly reports to see our progress. We aim to identify patterns in our anesthetic gas use across all Mass General locations, and use this knowledge to find ways to safely cut it back and change it, as necessary. 

Q. What “wins” has the committee achieved to date?

Dr. Smith: Two years ago, we began our efforts to educate our colleagues and raise awareness of the impact of anesthesia on the environment. Since then, the department has reduced its anesthesia-related carbon footprint by 75%. 

Dr. Everett: 

We have had many successes, including: 

  • We have created a reporting system within Epic, our electronic health record system, to monitor and analyze the carbon dioxide equivalents (KgCO2) associated with each anesthetic gas. This allows us to break down the emissions by the type of medical case, service, and the healthcare provider responsible. 
  • We organized and launched a robust internal education program on climate change and anesthesia, which is led by Dr. Smith. 
  • We have added sustainability-based performance measures into our internal provider-facing email communications. 
  • We have added a high fresh gas flow alert to our electronic health record system. 

Q. What are the current challenges it faces?

Dr. Lucinda Everett
Dr. Lucinda Everett


Dr. Smith: There is still a lot of education needed to help providers understand the environmental impact of anesthetics and other health care amenities. This is particularly true, as we are always welcoming new staff and residents to the department. 

Dr. Everett: We are still figuring how to sustain our success over the long term. For example, we are currently investigating methods to analyze the environmental impact of other aspects of health care, such as plastic usage, pharmaceutical waste, and leaks that occur in the hospital’s nitrous oxide supply system. 

Q. How does improving the sustainability of anesthesia practice improve patient care?

Dr. Smith: Our goal is to champion ideas that improve our impact on the environment while also providing the highest quality of care for patients—never one at the expense of the other. It’s fortunate that some of the best anesthetic regimens for reducing a patient’s risk of post-operative nausea—which is one of the most significant factors related to patient satisfaction ratings with anesthetic care—are also the most beneficial anesthetic choices to reduce global warming. Of course, by enhancing the sustainability of our hospital practices, we are actively advancing the global Net Zero objectives. This, in turn, plays a significant role in reducing worldwide illness and mortality associated with climate change. Small improvements by all of us, no matter where or when, have a substantial and meaningful impact.   

Dr. Everett: It’s a win-win. If we can cut the cost of care, improve the sustainability of our approaches, and continue to provide excellent patient care, everybody benefits. It’s important to say that making changes to benefit the global environment will lead to a reduced risk of climate change-related adverse health effects for the general public. 

Q. How are you looking to expand this committee in the future?

Dr. Smith: Our next steps include further reducing Mass General’s carbon footprint, conducting primary research to explore strategies to reduce plastic waste, and advocating for increased efficiency in facility and equipment utilization. 

Dr. Everett: We have recently finished creating an Epic dashboard, offering individuals the ability to delve into their personal results with greater detail. We have tested one product to capture and recycle anesthetic gases and are looking at other options. We are also planning to pilot the showcasing of real-time calculations of the environmental impact of gases in the electronic record.