[Anesthesia and climate protection: Role of volatile anesthetics. German version]

Volatile anesthetics represent a relevant yet largely avoidable source of greenhouse gas emissions in the healthcare system. In Germany, their use accounts for approximately 69 kt of CO₂ equivalents annually. While desflurane is used in only about 3% of inhalation anesthesia procedures, it is responsible for more than 50% of the associated emissions due to its extremely high global warming potential. Modelling studies indicate that complete substitution of desflurane with sevoflurane would reduce total emissions by approximately 53%; replacing isoflurane as well would increase the reduction to 65%. From a clinical perspective, desflurane offers no proven advantage over sevoflurane with respect to patient safety or postoperative outcomes. Isoflurane likewise shows no clinical superiority. This creates substantial scope for substitution without compromising quality of care. Under minimum alveolar concentration (MAC)-adjusted conditions, desflurane causes an approximately 34-fold higher global warming per anesthesia hour than sevoflurane. The contrast is even greater when compared to total intravenous anesthesia (TIVA). Of particular relevance is the short-term climate impact. Due to its high radiative efficiency, desflurane exerts most of its warming effect within a few decades, precisely the critical period up to 2050. In addition, volatile anesthetics contribute to environmental contamination with persistent perfluoroalkyl and polyfluoroalkyl substances (PFAS), posing potential long-term risks to ecosystems and human health. Eliminating desflurane requires no new infrastructure, is economically rational and can be implemented immediately. It hence represents a rare opportunity in the healthcare system to achieve rapid and substantial emission reductions through a simple clinical decision, while maintaining patient safety and quality of care.