Changi General Hospital becomes Singapore's first desflurane-free hospital

MEDIA RELEASE

Changi General Hospital becomes Singapore's first desflurane-free hospital
The milestone elimination of desflurane is part of CGH’s coordinated hospital-wide journey to embed sustainability practices into everyday healthcare delivery

Singapore, 1 July 2026 – Changi General Hospital (CGH) has eliminated the use of the anaesthetic gas desflurane, one of healthcare’s most high-impact greenhouses gases, from all surgical procedures, becoming the first hospital in Singapore to do so. This initiative reduces carbon emissions by replacing desflurane which otherwise would have been released into the environment. Reduction of annual carbon emissions are estimated to be over 900 tonnes from peak desflurane usage, with actual annual reduction based on desflurane usage levels.

The process of elimination began in 2019, when CGH's Department of Anaesthesia and Surgical Intensive Care started reducing desflurane use, in favour of equivalent alternative inhalational anaesthetic gases, through staff education and gradual changes to clinical practice.

In 2019, CGH was operating at a usage of 242 litres of desflurane. In 2025, usage significantly reduced by 99.4% – down to just 1.44 litres, representing a reduction of approximately 895 tonnes of CO₂-equivalent emissions. Since September 2025, desflurane has not been used for surgeries at CGH, and in 2026, remaining bottles and vaporisers were removed from the hospital and returned to vendors.

Desflurane is an inhaled anaesthetic gas that was once widely favoured for its perceived clinical advantages in surgery. However, subsequent evidence has since shown that alternatives, such as sevoflurane and propofol, can offer comparable clinical outcomes as well as a more favourable environmental impact. Compared to sevoflurane, desflurane has a global warming potential approximately 20 times greater. To put into perspective, using desflurane over one hour of surgery produces the same carbon emissions as driving a car from Singapore to Kuala Lumpur – approximately 300km. The same amount of sevoflurane, by comparison, produces carbon emissions equivalent of just 6.5km of driving.

Dr Joanne Yeo, Consultant, Department of Anaesthesia and Surgical Intensive Care, and Institution Sustainability Officer, Changi General Hospital, said, “The process to eliminate desflurane at CGH was deliberately gradual to ensure a smooth and sustainable change in practices. It involved a lot of staff education and engagement, and required our care team to change long-established clinical habits. For instance, we implemented limiting access to desflurane vaporisers in the operating theatres, and made desflurane available only on demand rather than as the default anaesthetic gas, allowing clinicians to transition to equally effective alternative gases while ensuring patient safety is never compromised.”

To complement efforts in desflurane reduction, CGH has also significantly reduced carbon emissions from nitrous oxide, also known as laughing gas, another type of inhalational anaesthetic gas. Research published by CGH in 2025 found that, in keeping with other hospitals worldwide, between 63% and 73% of the hospital's procured nitrous oxide was being lost to the atmosphere through leakage in its centralised manifold and pipeline system. A potent greenhouse gas, this nitrous oxide leakage is equivalent to over 400 tonnes of CO₂-equivalent emissions being wasted annually.

In September 2024, CGH decommissioned its centralised nitrous oxide manifold system and switched to portable point-of-care gas cylinders mounted directly on anaesthesia machines in operating theatres. Nitrous oxide procurement reduced by 91.4% – from 113,333 litres per month in 2023 to just 9,737 litres per month in 2025. Clinical usage has remained stable, confirming that the majority of prior procurement had been wasted due to leakage to the environment.

Clinical Professor Ng Kee Chong, Chief Executive Officer, CGH, said, “Sustainability in healthcare is not just about reducing our environmental footprint. It is about recognising that the health of our patients and the health of our planet are deeply connected. The work that our teams have achieved across the hospital reflects CGH's belief that good healthcare must also be responsible healthcare.”

Giving new life to hospital waste

Across the hospital, CGH's sustainability efforts are driven by a multidisciplinary team spanning perioperative care, pharmacy, data analytics, environmental services, operations, and facilities management – bringing together diverse expertise to embed sustainable practices into everyday healthcare delivery.

When the CGH sustainability committee identified that retired hospital scrubs were being sent for incineration, they worked with the hospital’s in-house seamstresses in the linen department to upcycle the fabric into reusable operating theatre caps.

To date, about 178kg of retired hospital scrubs have been transformed into over 420 reuseable caps, with an estimated reduction of 5,041kg CO₂-equivalent emissions through avoided incineration and fewer production of new caps, while also reducing the number of disposable caps used.

Since 2022, CGH's Food Services team has also made meaningful contributions to the hospital's sustainability goals through multiple initiatives. This includes introducing food upcycling, eliminating single-use disposables, switching to reusable tableware to serve staff meals, switching from single-use plastic bags to reusable bowls for cut fruits, and digitalising meal order forms.

To tackle food waste, research and development was done to produce sustainable, nutritious and tasty food items, for instance, using still-good but stale bread to make bread puddings or repurposing bread crusts to make pizza. Browned or otherwise unappealing whole bananas that would not be served to patients are also used to make desserts, such as banana bread, crumbles and cake trimmings. Remaining food waste is diverted to an on-site food digestor, which produces water used for washing outdoor areas.

To date, this has achieved further annual carbon footprint reductions of 57,518kg CO₂-equivalent emissions, and waste reductions of 41,202kg of food, packaging, single-use disposables, and paper.

Clin Prof Ng said, “These efforts sit alongside a broader programme of sustainability initiatives across our campus – from solar energy generation and heat recovery systems to rainwater harvesting and plastics recycling. We see this not just as an endpoint but as an ongoing journey and commitment for CGH to our patients, community and environment, and we are actively looking at how we can scale and extend these practices across more areas of the hospital. Ultimately, it is our goal for everyone at CGH to be a sustainability guardian.”

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Global Warming Potential of 100 years (GWP100)

Global Warming Potential of 100 years (GWP100) is a commonly used metric to quantify greenhouse gas emissions. Carbon dioxide is defined as having a GWP100 of 1.The GWP100 of desflurane is 2540, with 1ml of desflurane amounting to around 3.72kg of CO₂ equivalent emissions. The GWP100 of sevoflurane is 130, with 1ml of sevoflurane amounting to around 0.196kg of CO₂ equivalent emissions. This makes desflurane almost 20 times worse in terms of carbon emissions and its environmental impact compared to sevoflurane.Nitrous oxide, another type of inhalational anaesthetic gases, has a GWP100 of 265 in addition to ozone depletion effects.