Anaesthetic gases, climate change, and sustainable practice

Modern anaesthetic gases include the hydrofluorocarbons sevoflurane and desflurane, the chlorofluorocarbon isoflurane, and nitrous oxide. Following use, anaesthetic gases are expelled into the atmosphere, where they contribute to anthropogenic climate change.1–5 Recently, the atmospheric concentrations of anaesthetic gases have been determined, and the most damaging agent, desflurane, is rapidly increasing.1 The Montreal protocol aims to phase out global chlorofluorocarbon use, with hydrofluorocarbons subsequently targeted through the 2016 Kigali amendment;6 however, anaesthetic gases are often excluded from such discussions because of their medical necessity.