Roanoke, Va.-based Carilion Clinic cut average greenhouse gas emissions per anesthetic episode by 45% and reduced spending on inhaled anesthetics by nearly 40% after changing routine anesthesia practices, according to a study presented at the American Society of Anesthesiologists’ Anesthesiology 2026 annual meeting in San Diego.
The six-site academic health system steered anesthesiologists toward sevoflurane and intravenous anesthesia, lowered fresh gas flow rates to reduce waste and gave clinicians individualized emissions reports. Neil Macdonald, MD, chair of the department of anesthesiology at Carilion and an associate professor at Virginia Tech Carilion School of Medicine in Roanoke, helped launch the feedback program, according to an Oct. 18 news release.
Researchers compared 2021 data with results from January 2022 through October 2025, covering 145,917 anesthetic episodes. Average emissions fell from 57.6 kilograms of carbon dioxide equivalent per episode to 31.6 kilograms. Desflurane use dropped from 23.8% of cases to 9.81%, while sevoflurane use rose from 82.4% to 93.1%.
Inhaled anesthetic spending declined from $628,588 in 2021 to $379,010 in 2024. By late 2025, the system had surpassed its goal of halving emissions.
Patient outcomes held steady, with no increase in recovery room stays, hospital stays, reintubation, awareness under anesthesia or postoperative nausea and vomiting. Lead author Etta Hanlon, a researcher at Virginia Tech Carilion School of Medicine, said the gains came from practical changes in anesthetic selection, waste reduction and clinician feedback rather than costly technology.
“Patients shouldn’t have to choose between environmentally responsible healthcare and safe, high-quality care,” said Sara Wohlford, director of sustainability at Carilion. Ms. Wohlford said the changes happen behind the scenes, so patients don’t need to do anything differently.
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