Desflurane's climate burden and the PFAS legacy of volatile anaesthetics

Efforts to reduce the environmental footprint of anaesthesia have focused predominantly on greenhouse gas emissions, with desflurane widely recognised as an extreme climate outlier. In Australia, desflurane accounts for approximately 3% of volatile anaesthetic cases yet contributes nearly 60% of volatile anaesthetic-related greenhouse gas emissions, making its phase-out one of the most effective mitigation measures immediately available to anaesthetists. However, climate forcing represents only one dimension of the environmental burden of volatile anaesthesia. All fluorinated volatile anaesthetics, including sevoflurane, desflurane and isoflurane, meet the Organisation for Economic Co-operation and Development definition of per- and polyfluoroalkyl substances (PFAS) that generate persistent degradation products, most notably trifluoroacetic acid, leading to irreversible accumulation in water, soil and biota. This Point of View examines both dimensions. We argue that desflurane represents a disproportionate climate burden, whereas PFAS pollution is an inherent class effect of volatile anaesthesia. Using quantitative estimates, we illustrate the scale of both impacts and consider the regulatory and ethical implications for Australian practice.