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Yale Gassing Greener: an App that Researches the Carbon Emissions of Anesthesia and Educates Providers
Session: MP-04b
Thurs, April 19, 3:30-5:00 pm
Uris (Shubert Complex), 6th floor

Please note, medically challenging cases are removed three months after the meeting and scientific abstracts after three years.


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Ø Healthcare sector emits 10% of total United States greenhouse gasses. In the United Kingdom,

2.5% of healthcare emissions from inhaled anesthetics. No U.S. data currently available1.

Ø Global warming potentials of inhaled anesthetics established2, while those of intravenous drugs

CO2 comprise a new area of investigation.

Ø Only 8.4% of survey respondents report sustainability in medical school/resident curriculum3.

Ø We feel that regional anesthesia helps decrease anesthesia-related greenhouse gas emissions, so

we built an educational app to address the knowledge gap and promote safer anesthesia.

Methods - Development

Ø Common intravenous and inhaled anesthetics were reverse engineered to common

chemicals, to determine the carbon dioxide impact using international databases1,4 and

integrated into a calculator and learning modules.

Ø A cost calculator was built using the Dion formula5 and retail prices from www.drugs.com.

Ø An alternate calculator was built for users to customize to their institution’s drug prices.

Ø Yale Gassing Greener (YGG) was launched internationally in the Apple App Store and

Google Play store in September 2016.

Ø Mobile software platform allowed regular updates of the calculators and education


Methods – Usage

Ø Home screen icons allow the user to navigate between the education modules, calculators,

and an optional facility-wide data collection tool.

Ø The education modules guide users through key teaching points demonstrating

differences in carbon emissions implications of various anesthesia practice choices.

Ø The calculator lets users input various anesthetic combinations and models carbon

emissions, equivalent miles driven

Discussion - 

Ø Creating a mobile teaching app with Cordova on Apple and Google

platforms is learnable for a lay programmer.

Ø Mobile dissemination of an educational tool to promote sustainable

practices appears to be promising.

Ø Tool is capable of demonstrating different environmental impacts and

costs associated with various anesthetic choices, e.g. general inhaled vs.

TIVA vs. regional anesthetics.

Ø Facility data difficult to acquire; useful in debugging. Most COis from

nitrous use, but this appears to be under reported or unobtainable.

Ø Future work involves quantifying the efficacy of the teaching app.


1. Eckelman MJ, Sherman JD. Estimated Global Disease Burden from US Healthcare Sector Greenhouse Gas

Emissions. Am J Public Health 2017;Epub ahead of print.

2. Sherman J, Le C, Lamers V, et al. Life Cycle of Greenhouse Gas Emissions of Anesthetic Drugs. Anesth Analg

2012;114: 1086-90.

3. Ard J, Tobin K, Huncke T, et al. A Survey of the American Society of Anesthesiologists Regarding Environmental

Attitudes, Knowledge and Organization. A&A Case Reports 2016;6:7: 208-216.

4. Parvatker A, Tunceroglu H, Sherman J, Coish P, Zimmerman J, Eckelman M. Life cycle inventory of twenty

common intravenous anesthetic drugs. (Manuscript in Process)

5. Dion P. The cost of anaesthetic vapours. Can J Anaesth. 1992;39:633.

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