The environmental impact of healthcare has become an increasing focus of policy and research, with anesthetic gases identified as a measurable contributor to greenhouse gas emissions. Among volatile anesthetics, desflurane has emerged as a particular concern because of its exceptionally high global warming potential. In response to growing evidence and international climate commitments, the European Union (EU) has introduced new regulations that significantly restrict the use of desflurane. This review explores the scientific and medical literature informing these regulatory changes and discusses their implications for anesthetic practice.

Desflurane has long been valued in clinical anesthesia for its low blood–gas solubility, which allows for rapid induction and emergence. Despite these advantages, its environmental footprint is substantial. Desflurane has a global warming potential many times greater than that of carbon dioxide and markedly higher than other commonly used volatile anesthetics, such as sevoflurane and isoflurane. Although it is used in a minority of anesthetic cases, it contributes a disproportionate share of anesthesia-related greenhouse gas emissions, making it a logical focus for regulatory intervention.

In 2023, the European Parliament approved revisions to the EU Fluorinated Greenhouse Gases (F-gases) Regulation as part of the European Green Deal. Under the revised regulations, routine use of desflurane as an inhalational anesthetic will be prohibited across EU member states beginning January 1, 2026. Continued use will be permitted only in exceptional clinical circumstances where no suitable alternative is available, and such cases must be supported by clear medical justification and documentation. The aim is to reduce emissions while preserving clinician autonomy in rare situations where desflurane may offer unique clinical benefit.

The medical literature supports this policy direction. Comparative studies have shown that replacing desflurane with agents such as sevoflurane or using total intravenous anesthesia can substantially reduce the carbon footprint of anesthesia without compromising patient safety or perioperative outcomes. Institutional initiatives aimed at reducing desflurane availability—such as targeted education and removal of vaporizers—have demonstrated rapid and sustained declines in its use, indicating that behavioral and system-level changes are feasible in routine practice.

From a clinical standpoint, the new EU regulations around desflurane are unlikely to negatively affect patient care. Advances in anesthetic techniques and pharmacology provide multiple alternatives that offer reliable anesthesia and predictable recovery profiles for most surgical procedures. Increasingly, professional guidance emphasizes aligning anesthetic choice principles of environmental sustainability, recognizing that desflurane’s limited advantages rarely outweigh its environmental harm in routine cases.

These regulations represent an important step toward environmentally sustainable healthcare. Grounded in a robust body of scientific and clinical literature, these measures aim to significantly reduce greenhouse gas emissions from anesthesia while maintaining high standards of patient care. The policy may also serve as a model for future environmental regulations in anesthesiology worldwide.

References

1. Sulbaek Andersen MP, Nielsen OJ, Wallington TJ, Karpichev B, Sander SP. Assessing the impact on global climate from general anesthetic gases. Anesth Analg. 2012;114(5):1081-1085. DOI: 10.1213/ANE.0b013e31824d6150

2. Sherman JD, Le C, Lamers V, Eckelman MJ. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg. 2012;114(5):1086-1090. DOI: 10.1213/ANE.0b013e31824f6940

3. McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth. 2020;125(5):680-692. DOI: 10.1016/j.bja.2020.06.055

4. White SM, Shelton CL, Gelb AW, Lawson C, McGain F. Principles of environmentally sustainable anaesthesia. Anaesthesia. 2019;74(1):73-83. DOI: 10.1111/anae.15598

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