Fantastic news today: NHS England is decommissioning desflurane which will no longer be used in NHS hospitals in England from January 2024.
It is wonderful to see decisive action from the health service to protect our climate. Congratulations to all of the members of this network who have contributed to raising awareness about desflurane's environmental harms and the preferability of clinical alternatives, and who have shown in practice that we can do without it!
Here's the statement from the Association of Anaesthetists and the Royal College of Anaesthetists, welcoming the decision: https://anaesthetists.org/Home/News-opinion/News/Joint-statement-on-NHSEs-plan-to-decommission-desflurane-by-early-2024 .
Update to post please read.
Desflurane is being removed from national procurment contract in Scotland from Feb 2023. We advocate that all Des stock is fully utilised ( but not reordered). Des stock in Scotland can be moved across sites where approriate. Empty bottles are disposed of in normal medicinal waste stream for incineration.
We are having some discussions WRT to full bottles that have expired.
Options include:
1. Placed bottles in cytoxic waste stream for higher temperature incineration but this will depend on NHS sites waste contract this has been suggested as a more appropriate stream.
2 Wait, and hold on to stock until research is concluded regarding the the the byproduct of high temperature. Given Desflluranes high GWP100 of 2540 we would anticipate that byproduct will have lower GWP100 but this has not been assured by the manufacturers or any physical chemists to date that I am aware of.
Alifia Chakera, Head of Pharmaceutical Sustainabilty Scot Gov.
I will update again
Thank you Alifia Chakera so much for this very helpful reply. I will convey to our pharmacy department.
We stopped using it 2 years ago at my hospital. Sadly we now have 11 bottles unopened and now out of date. I am really frustrated as we contacted the supply company way back but they would not receive them back and then we didnt know which was the lesser of the two evils-use it clinically or incinerate them!
We are in discussions with physical chemists at Heriot Watt on the best way to destroy volatile products without producing toxic by products.
High heat incineration is unlikely to be effective. So interim advice is to hold on to expired sealed stock until a full review and recommendation are made available.