IMPLEMENTATION OF A STRUCTURED PHASE-OUT OF DESFLURANE TO REDUCE THE ENVIRONMENTAL IMPACT OF ANAESTHESIA IN A UNIVERSITY HOSPITAL
European Statement
Introductory Statements and Governance
Author(s)
Federica Pieri, Barbara Crivelli, Beatrice Faitelli
Why was it done?
Desflurane is an inhalational anaesthetic agent with an extremely high global warming potential (GWP100 ≈ 2,540), representing a major contributor to greenhouse gas emissions from operating theatres. The 2024 European F-gas Regulation mandates a progressive phase-out of fluorinated gases, including a complete ban on desflurane from January 2026. In anticipation of this regulation, our hospital sought to reduce its environmental impact by eliminating desflurane use and promoting more sustainable anaesthetic techniques.
What was done?
A multidisciplinary sustainability programme was launched to achieve complete phase-out of desflurane by December 2025, replacing it with sevoflurane and total intravenous anaesthesia (TIVA) using propofol. The goal was to maintain clinical effectiveness and patient safety while engaging anaesthetists in environmentally responsible practices.
How was it done?
A task force composed of Pharmacy, Anaesthesiology, Biomedical Engineering and Environmental Safety departments developed a structured plan that included:
Baseline assessment of desflurane, sevoflurane, and nitrous oxide consumption; Educational sessions on environmental impact and low-flow anaesthesia (<1 L/min); Gradual removal of desflurane vaporizers from operating theatres; Monitoring of TIVA adoption and evaluation of gas-scavenging systems. Environmental impact was quantified as CO₂ equivalent (CO₂e) using GWP100 factors (Desflurane = 2540, Sevoflurane = 130, N₂O = 298).
What has been achieved?
Between 2024 and 2025, desflurane use was reduced by more than 85%, replaced by sevoflurane and TIVA. This resulted in an estimated >80% reduction in anaesthetic gas-related CO₂ emissions, equivalent to several tonnes of CO₂ avoided annually. No adverse clinical outcomes were observed and staff feedback highlighted increased awareness and acceptance of environmentally sustainable practices.
What next?
The next steps include full desflurane disposal by December 2025, continuous monitoring of sevoflurane and TIVA use and expansion of the sustainability programme to other anaesthetic and perioperative practices. This structured approach demonstrates the pivotal role of hospital pharmacists in climate-conscious healthcare and provides a replicable model for other institutions preparing for the 2026 EU ban.
Oxygen therapy in COVID-19 pandemic: how to keep breathing at home
European Statement
Selection, Procurement and Distribution
Author(s)
Elena Bazzoni, Roberto Pane, Claudia Montanari, Giulia Rocca, Camilla Ercoli, Maurice Oriente De Ponzio, Thérèse Gregori, Simonetta Radici
Why was it done?
Piacenza is one of the most hardly hit cities in Italy during the first wave of COVID-19. Due to the severe impact that this pandemic had in the area, hospitals were saturated with patients with respiratory failure. We thus needed to rapidly set strategies that allowed a fast dismissal of patients from the hospital without interrupting their oxygen therapies or avoid their hospitalization in case of mild respiratory failure.
What was done?
Starting from COVID-19 pandemic, our pharmaceutical unit cooperated with medical doctors of the area to allow home-delivery of oxygen therapies and grant continuity between hospital and territory. We thus developed a structured system that allowed fast activation, efficient tracking, prompt variations, and dismissal of patients from oxygen therapies at their house.
How was it done?
Since February 2020, all the oxygen therapy prescriptions from the hospital and the territory converged to the pharmaceutical service. In collaboration with the pneumology unit, we set up a database collecting patient generalities who needed oxygen therapy to grant the proper follow-up during the pandemic. In April 2020 the database was shared also with medical doctors belonging to the newly formed Special Unit for Assistential Continuity (USCA). This team was in charge of visiting patients at their houses. In collaboration with USCA and the IT service, we developed a web-based system that allowed real-time communication between Pharmacy, USCA teams, and some hospital units granting the continuity between hospital and territory.
What has been achieved?
From the beginning of the pandemic, the pharmaceutical unit has handled more than 960 requests of oxygen therapies regarding more than 900 patients. Our database is updated with all of the patients granting the tracking of each one of them as well as the therapies assigned. Our system also allowed USCA to follow patients on the territory reducing the pressure on hospitals. In 2020, indeed, more than 75% of oxygen prescriptions were requested by hospital units while in 2021, 81% of them came from USCA and territorial units.
What next?
Our currents efforts aim to reduce procedural complexity to grant access to pharmacological therapies. This new web-based system represents, indeed, an versatile and key tool to reach our goal. We are currently extending its use to the whole hospital for oxygen therapies independently of the underlying pathologies. This will allow an easy and complete transfer of these therapies on the territory. Moreover, we are implementing the possibility to prescribe drug-based pharmacological therapies in an in-home context.