What started as a simple observation quickly became one of Singapore’s most successful stories in operating theatre sustainability. At the National University Hospital (NUH), a team of anaesthetists led by Dr Poh Pei Kee set out to drastically reduce the use of desflurane, a commonly used anaesthetic gas with a disproportionately large carbon footprint.
The Challenge
Desflurane is favoured for its pharmacokinetic properties, but it carries a significant environmental cost. With a global warming potential (GWP) of 2,590, it far exceeds that of other anaesthetic agents. As a result, several countries have banned its use.
Yet change in healthcare isn’t driven by data alone—it also depends on trust, culture, and timing. At NUH, initial efforts to reduce desflurane met with resistance. Some clinicians felt the initiative implied a lack of trust and compromise a clinician's authority.
The Approach
The team led with evidence and balanced it with empathy. Education was their first lever—raising awareness about desflurane’s environmental impact and viable alternatives. They hosted talks with international experts to highlight how other countries had successfully phased it out. Visual reminders, such as stickers on anaesthetic machines, reinforced the message. Most importantly, they embedded sustainability into the clinical curriculum to ensure lasting change.
Desflurane remained available by request. By respecting physician autonomy while sharing clear data, the team achieved what a formal ban might not have: sustained, voluntary behaviour change.
The Impact
What began as a single-issue intervention has become a case study in clinician-led transformation. Since 2021, NUH has reduced desflurane use by 98%—the carbon savings equivalent to removing 411 cars from Singapore’s roads each year. The shift has also saved an impressive SGD $340,000 annually.
More importantly, it sparked a mindset shift: sustainability is no longer a side quest—it’s now seen as integral to delivering quality care.
There’s no one-size-fits-all solution to sustainability in healthcare. But this project proves that when clinicians are given the facts and the tools, they can be trusted to lead meaningful change.
Today, desflurane is virtually obsolete at NUH—without ever being banned.
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For more information
King Sin Ang, Zhao Kai Low, Bryan Su Wei Ng, Pei Kee Poh, Developing a quality improvement project to tackle the desflurane problem, British Medical Journal, 2023
Acknowledgements
The Centre for Sustainable Medicine would like to thank Dr Poh, Dr Ng, Dr Ang, and the whole medical team for championing sustainability in anaesthesia.