Sustainable anaesthesia advances responsible healthcare
Changi General Hospital (CGH) has become Singapore’s first desflurane-free hospital, eliminating the use of the high-emission anaesthetic gas from all surgical procedures while adopting alternatives that provide comparable clinical outcomes and lower environmental impact.
The initiative began in 2019, when CGH progressively reduced desflurane use through staff education and changes to clinical practices. Annual usage fell from 242 litres in 2019 to just 1.44 litres in 2025, representing a 99.4 per cent reduction and an estimated reduction of about 895 tonnes of CO₂-equivalent emissions. Since September 2025, desflurane has not been used for surgeries at CGH, and remaining bottles and vaporisers were removed in 2026.
CGH replaced desflurane with alternatives including sevoflurane and propofol, which offer comparable clinical outcomes while reducing environmental impact. Compared with sevoflurane, desflurane has a global warming potential approximately 20 times higher, making its elimination a significant step in reducing healthcare-related carbon emissions.
The hospital has also reduced emissions from nitrous oxide, another greenhouse gas used in healthcare. In 2024, CGH decommissioned its centralised nitrous oxide manifold system and switched to portable gas cylinders mounted directly on anaesthesia machines in operating theatres. Monthly procurement decreased by 91.4 per cent between 2023 and 2025, showing that previous supply losses were largely due to leakage from the system.
Beyond operating theatres, CGH has expanded its sustainability efforts across the hospital. Retired hospital scrubs are being transformed into reusable operating theatre caps, with about 178kg of fabric repurposed into more than 420 caps. The initiative has reduced an estimated 5,041kg of CO₂-equivalent emissions through avoided incineration and reduced production of new caps.
The hospital’s Food Services team has also introduced food upcycling, reusable tableware, digital meal ordering and food waste reduction measures. These initiatives have contributed to annual reductions of 57,518kg of CO₂-equivalent emissions and 41,202kg of waste.
The milestone reflects CGH’s ongoing commitment to integrating sustainability into everyday healthcare delivery. Through continued innovation and collaboration across departments, the hospital aims to expand responsible practices that support patients, the community and the environment.
Source: Singhealth
