In 2016, Leydamara Carvajal, MD, began exploring whether eliminating the use of desflurane could have negative implications for patient care.
After digging into research, Dr. Carvajal, an anesthesiologist and the operating room medical director at PeaceHealth Southwest Medical Center in Vancouver, Wash., did not find any significant downsides. "When I really looked at this back then, I really didn't see that it was clinically superior in any situation," she told Becker's.
Increasingly, health systems are eliminating or significantly rolling back the use of the anesthesia gas known to linger in the atmosphere for more than a decade. In the past, it was the preferred anesthetic because the body clears it quickly and patients come to within minutes of the gas being turned off. In recent years, however, many large health systems have announced plans to cease its use entirely in an effort to adopt more environmentally friendly practices.
Now, two other inhalational agents, sevoflurane and isoflurane, are considered the preferred options because they are easier on patients' airways and less taxing on the environment.
PeaceHealth is the first system in the Pacific Northwest to have stopped using desflurane systemwide, Dr. Carvajal said. She described desflurane as being "a little bit of a crutch" for anesthesia providers earlier on since the emergence time — which refers to how long it takes for patients to wake up after the breathing tube is removed — was quick and consistent, with patients often waking up within five minutes.
After reviewing studies about how the emergence time between desflurane and sevoflurane may differ, Dr. Carvajal said no clinically significant differences stood out.
"We were talking about differences of one to two minutes, not hours, or even 15 minutes," she said.
Desflurane is also more costly than sevoflurane, as it needs to be used in higher concentrations to deliver the same effects as other agents.
For systems navigating a full discontinuance of desflurane's use in clinical practice, Caoimhe Duffy, MD, assistant professor of anesthesiology and critical care at the Hospital of the University of Pennsylvania in Philadelphia, part of Penn Medicine, recommends adopting a well-structured quality improvement approach.
Such a plan should include assessing current usage and staff opinions, setting clear goals and using Plan-Do-Study-Act cycles to test and refine interventions, and gradually reducing the availability of desflurane in clinical settings, Dr. Duffy said.
With Dr. Duffy's support, Penn Medicine aims to fully phase out the use of desflurane by the end of the year. Already, it has stopped using the anesthetic in four of its six hospitals, including HUP.
At PeaceHealth, gradually making desflurane less available was an effective strategy when working to fully end its use, Dr. Carvajal said.
"When it became less convenient, people just naturally started using it less," she said. "Then it got to the point where they were like, 'I don't really need it,' and by the time it was gone, there was very, very little resistance."
A positive unintended consequence of its removal has been heightened awareness and engagement with other sustainability efforts among staff.
"We've just had a snowball effect in terms of developing other efficient, green sustainable projects in the OR that have gone way beyond just desflurane," Dr. Carvajal said. "We've partnered with the community to recycle the glass vials we use in the OR. … We're recycling the blue wrap that all of the sterile instrumentation comes in."
"It has the effect of making people feel proud to be involved in something that's really important," she said.
Ultimately, Dr. Carvajal and Dr. Duffy agree that ending the use of desflurane is an opportunity to improve practice and lower costs, with minimal effects to patient care. Penn Medicine estimates it will save about $40,000 per year by eliminating desflurane at a single hospital.
"Any competent anesthesia provider should be able to give good, safe, effective anesthetic care without this drug, and I 100% stand behind that statement," Dr. Carvajal said.