Dissertation
Reducing the Carbon Footprint of Anesthesia Services at a Large Academic Medical Center
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
Abstract
Background: Inhaled anesthetic agents contribute significantly to healthcare-related greenhouse gas (GHG) emissions. Anesthesia practice is a modifiable source of environmental impact. Purpose: The purpose of this project was to reduce the carbon footprint of anesthesia services at a large academic medical center by increasing provider awareness of and comfort levels with environmentally sustainable anesthesia practices, eliminating desflurane and N2O use, increasing utilization of low-flow anesthesia, and increasing use of alternative anesthesia techniques such as total intravenous anesthesia (TIVA), neuraxial anesthesia, and regional anesthesia. Methods: This project followed a Quality Improvement (QI) framework guided by the Iowa Model of Evidence-Based Practice to promote quality care. A multimodal educational intervention was delivered to anesthesia providers. A pre- and post-survey were provided to measure provider attitudes toward environmentally sustainable anesthesia practices. Aggregate anesthesia record data was collected pre- and post-education on low-flow technique, desflurane and N2O use, and alternative techniques. Data was analyzed using chi-square tests and independent sample t-tests. Findings: Post-education, anesthesia providers self-reported improvements in understanding of environmental impact, perceived importance of sustainability, and routine consideration of environmental factors in clinical decision-making (p < 0.001). The pre-education survey was completed by 32 providers, and the post survey was completed by 25 providers. A six-month pre-intervention baseline (n = 35,518 anesthetics) was compared with a two-month post-intervention period (n = 12,565 anesthetics). Following implementation, desflurane and N2O use was eliminated, low-flow anesthesia practices increased, particularly use of ultra-low-flow anesthesia, and utilization of alternative techniques increased significantly (p < 0.001). Discussion: An environmentally sustainability-focused educational intervention implemented within the Iowa Model framework was associated with measurable improvements in anesthesia practice patterns and self-reported provider knowledge. Education represents a feasible, low-cost strategy to advance environmental stewardship within academic anesthesia departments.
Details
- Title: Subtitle
- Reducing the Carbon Footprint of Anesthesia Services at a Large Academic Medical Center
- Creators
- Eliza Bender - University of Iowa
- Contributors
- Cormac O'Sullivan (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Nurse Anesthesia
- Date degree season
- Spring 2026
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2026 Eliza Bender
- Language
- English
- Academic Unit
- College of Nursing; Doctor of Nursing Practice Projects
- Record Identifier
- 9985217823202771
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