Dear Editors of Universitas Medica:

We read with great interest the article “Inhaled Anesthetics and the Environment: Carbon Footprint of a Colombian High-Complexity Hospital” by Grueso et al. (Universitas Medica, Vol. 66, 2025). (1) We commend the authors for addressing the environmental impact of anesthetic gases within the context of local clinical practice. Given the relevance of this topic, we would like to contribute additional perspectives from recent literature that nuance the interpretation of environmental risk.

The article states that modern volatile anesthetics are poorly metabolized halogenated compounds and that, once exhaled, they are released into the atmosphere with a greater global warming potential (GWP) than carbon dioxide. It further suggests that the use of desflurane by a single anesthesiologist may be equivalent to the carbon dioxide emissions associated with driving more than one thousand kilometers in a single workday. (1)

However, recent analyses have highlighted important limitations in the use of CO₂-equivalent comparisons for short-lived anesthetic gases. (2-4) Slingo et al. have argued that translating GWP values into CO₂-equivalent analogies —such as vehicle emissions— is inherently misleading. Although mathematically correct, a pulse emission of desflurane does not produce climate effects comparable to an equivalent mass of CO_₂, given the markedly different atmospheric lifetimes and accumulation profiles of these gases. In this context, anesthetic agents do not have a directly equivalent carbon footprint based solely on GWP metrics. (2)

These conceptual concerns have been reinforced by recent climate physics modeling. Marin and Kleinberg demonstrated that sustained desflurane emissions over a century would not lead to progressive increases in global temperature but instead to a small, stable step change (approximately 0.00015 °C), which is reversible within decades after discontinuation. This behavior contrasts sharply with that of long-lived greenhouse gases such as carbon dioxide. (3)

From a clinical standpoint, this evolving evidence has prompted a reassessment of environmental narratives surrounding desflurane. Kranke et al. emphasize that GWP is an oversimplified metric that fails to capture the transient atmospheric behavior of short-lived agents. Importantly, they underscore that desflurane’s climate impact is negligible and reversible, while its clinical advantages —particularly rapid and predictable emergence—remain highly relevant for vulnerable populations, including elderly, obese, pediatric, neurosurgical, and cardiac patients. (4)

Additionally, Figure 4 of the article, which estimates costs for the health system, would benefit from further methodological clarification. Our review of publicly available SISMED data suggests only a modest price difference between sevoflurane and desflurane, with sevoflurane being approximately 10% less expensive per milliliter. (5)

In conclusion, a rigorous understanding of atmospheric chemistry and climate physics is essential for accurately assessing the environmental impact of halogenated anesthetics. Preserving the full anesthetic armamentarium—including agents such as desflurane—should not be viewed as incompatible with climate goals, but rather as a prerequisite for safe, flexible, and patient-centered anesthetic care.

References

Author notes

Correspondence address: franklinruizgomez@gmail.com