Percentage of cases where carbon dioxide equivalents (CO2 eq) normalized by hour for cases receiving halogenated agents and/or nitrous oxide is less than CO2 eq of 2% sevoflurane at 2L FGF = 2.83 kg CO2/hr during the maintenance period of anesthesia OR the Total CO2e is less than 2.83 kg CO2.
Reducing emissions can decrease public health harm and cost of anesthesia without compromising patient care. 1–13
“Global Warming Potential (GWP) is a measure of how much a given mass of greenhouse gas contributes to global warming over a specified period of time. The Intergovernmental Panel on Climate Change uses 100 years; however, 20, 50, 500 years are common as well, depending on the gas in question. GWP is a relative scale that compares the contribution of the gas in question to that of the same mass of carbon dioxide. The GWP of carbon dioxide, by definition, is one.”8
Mean efficiency less than or equal to carbon dioxide equivalents of 2% sevoflurane at 2L FGF = 2.83 kg CO2/hr
OR
Total CO2eq for the case is less than or equal to 2.83 kg CO2
Measure Start
Measure End
Artifact Values for flows and inhalational agents will be assessed and considered as artifact if inside the following ranges:
CO2 equivalents determined by calculating the pollutant total for the time period and dividing by the total number of minutes during the maintenance period.
Pollutant total: [Inspired agent concentration (%) * fresh gas flow (l/min)] * GWP100 ]
* CO2 eq for Sevoflurane, Isoflurane or Desflurane (%):
** CO2 eq For Nitrous Oxide:
For cases with documented Nitrous Oxide % but Nitrous Oxide flow is not reported, then use Nitrous Oxide % and FGF:
For cases with both valid Nitrous Oxide % and Nitrous Oxide flows reported, only Nitrous Oxide flow values will be considered (N2O values reported as % will be ignored):
From Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice:
“Global Warming Potential (GWP) is a measure of how much a given mass of greenhouse gas contributes to global warming over a specified period of time. The Intergovernmental Panel on Climate Change uses 100 years; however, 20, 50, 500 years are common as well, depending on the gas in question. GWP is a relative scale that compares the contribution of the gas in question to that of the same mass of carbon dioxide. The GWP of carbon dioxide, by definition, is one.”(Greening the Operating Room )
Agent |
Global Warming Potential100 |
Atmospheric Lifetime (years) |
Molecular Weight (g/mol) |
---|---|---|---|
Isoflurane12 |
565 |
3.2 |
184.5 |
Sevoflurane11 |
144 |
1.1 |
200 |
Desflurane12 |
2540 |
14 |
169 |
Nitrous Oxide13 |
282* |
114 |
44 |
Table adapted from American Society of Anesthesiologists’ Task Force on Environmental Sustainability Committee on Equipment and Facilities: Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice(?Greening the Operating Room )
*Nitrous oxide value is derived as an average of the range provided on the EPA website: 265-298.
Coming Soon! Carbon dioxide equivalents will be converted to miles driven equivalents based on EPA data found here: https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator
Not applicable
All providers signed in for at least 30 minutes during the time when halogenated agent or nitrous oxide are documented.
Measure Author |
Institution |
Nirav Shah, MD |
University of Michigan |
Jodi Sherman, MD |
Yale School of Medicine |
Meridith Wade, MSN, RN |
University of Michigan |
Kate Buehler, MS, RN |
University of Michigan |
Rob Coleman |
University of Michigan |
MPOG Quality Committee |
Date Reviewed | Reviewer | Institution | Summary | QC Vote |
---|---|---|---|---|
NA |
NA |
NA |
NA |
NA |
Date | Criteria | Revision |
---|---|---|
01/17/2023 | Other | Updated GWP for Desflurane from 2720 to 2540 |
10/27/2022 | Success | Added Total CO2e < 2.83 as Passing criteria |
08/30/2022 | Measure Start | Changed from Induction Start to Intubation Time |