Leading by example: how WashU Anesthesiology champions sustainability in health care

In recent years, the Department of Anesthesiology at WashU Medicine has demonstrated an impressive commitment to sustainability, reflecting a broader responsibility to environmental stewardship in health care. This dedication was recognized in 2023 when the department earned the prestigious Gold Badge from the Office of Sustainability, after receiving silver in 2022 and bronze in 2021. The award will be presented during WashU’s Green Carpet Awards Ceremony in February 2025, which celebrates excellence across four key sustainability areas: energy efficiency, waste management, responsible purchasing, and fostering a sustainable office culture.

The department’s Green Team, led by Assistant Professor of Anesthesiology, Helga Komen, MD, MBA, and Pod Leader, Elizabeth Schappe, CRNA, meets quarterly to drive these initiatives forward. Other members include Professor of Anesthesiology, Ivan Kangrga, MD; Assistant Professors of Anesthesiology, Leon Du Toit, MD, and Bethany Pennington, PharmD; Associate Professor of Anesthesiology, Ryan Guffey, MD; and Nurse Anesthetist, Julia Downey, CRNA. Together, they champion initiatives such as “Low Flow Anesthesia,” which aims to reduce environmental impact while maintaining patient safety.

Recently, they endorsed the Anesthesia Patient Safety Foundation’s (APSF) guidelines for low-flow Sevoflurane (SEVO) administration, which recommend maintaining a fresh gas flow (FGF) rate of 0.5–1.0 L/min as a safe, eco-friendly practice. This initiative encourages anesthesia providers to minimize gas flows while ensuring patient safety. Currently, the SEVO average FGF rate for Barnes-Jewish Center (BJC) is 2.085 L/min and the FGF rate for Barnes-Jewish Hospital (BJH) is 1.772L/min.

To celebrate excellence in the practice of Low Flow Anesthesia, champions from three groups—attending physicians, residents, and CRNAs—were recognized for achieving the lowest fresh gas flows over the past six months. Congratulations to our leaders, whose accomplishments highlight the team’s commitment to eco-friendly practices:

Additionally, to recognize team members who had the most significant reductions in their emissions month over month, the department planted trees in their honor through OneTreePlanted. Honorees include Nurse Anesthetists, Dani Benematti, CRNA, Tom Bozada, CRNA, and Ben Snyders, CRNA; Associate Professor of Anesthesiology, Preeta George, MD; Residents Ashton Shaffer, MD, and Dominique Williams, MD; Assistant Professors of Anesthesiology, Megan Dewey, MD, and Greg Miller, MD.

“Implementing Low Flow Anesthesia is a significant step in reducing our carbon footprint without compromising patient care,” said Komen. “It’s inspiring to see our team embrace these guidelines and lead by example. Every small change in our practice can have a big impact, and we’re proud to work together toward a more sustainable future.”

In another forward-thinking initiative, Barnes-Jewish Hospital discontinued piped nitrous oxide (N₂O) in its operating rooms as of October 2024. Research reveals that 75-95 percent of N₂O leaks from central piping before reaching patients, resulting in substantial waste and pollution. As a potent greenhouse gas with a long atmospheric lifespan, N₂O significantly contributes to ozone depletion. The decision to discontinue piped nitrous oxide underscores the department’s commitment to adopting sustainable practices.

The department is also advancing its environmental mission through the “Greenhouse Gas Project,” launched by Russell Groener, MD, associate professor of anesthesiology, within the Division of Pediatric Anesthesiology. The project aims to cut the division’s greenhouse gas emissions by half within a year, demonstrating a departmental commitment to setting and achieving meaningful sustainability goals.

Looking to the future, the department is partnering with the BJH Green Team and the BJH Waste Segregation Committee to introduce operating room waste segregation and recycling initiatives. These efforts seek to minimize the carbon footprint of perioperative processes while optimizing resource use.

The Department of Anesthesiology is setting a new standard for sustainability at WashU Medicine, proving that environmental stewardship and clinical excellence can—and must—go hand in hand. For more information about these initiatives or to join WashU Medicine’s Green Office community, visit the Office of Sustainability’s website.