Protecting clinician autonomy and patient safety within the climate debate: the case for desflurane in modern anaesthesia

Abstract

Purpose of review – The anaesthesia community should play a more active role in shaping sustainable healthcare practices. Current environmental measures, such as the European Commission’s impending restriction on desflurane (an inhaled anaesthetic) from January 2026, risk unintended consequences for patient care and clinical autonomy. Recent findings – While desflurane’s high global warming potential (GWP) has been the central justification, GWP is an oversimplified metric that fails to reflect the transient atmospheric behaviour of short-lived gases like desflurane compared with long-lived gases like carbon dioxide (CO2). Recent climate modelling shows desflurane’s impact on global temperature is negligible, reversible, and overstated by CO₂-equivalence comparisons. Clinically, desflurane offers significant advantages, including rapid, predictable emergence, particularly beneficial for high-risk patient groups, such as elderly, obese, paediatric, neurosurgical, and cardiac patients. Summary – Blanket restrictions undermine anaesthetists’ ability to tailor care, and limit training, resilience, and preparedness in the face of drug shortages. We urge policymakers to support anaesthetic diversity and protect desflurane’s availability where use is clinically justified. Sustainability efforts should focus on high-impact areas like energy use, equipment manufacturing, and waste, rather than eliminating valuable pharmacological options. Patient safety and evidence-based practice must remain central as we strive toward a more responsible, nuanced environmental approach in anaesthesia.