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
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 CO2 is 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
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.