Priority cases for remifentanil use and inhaled anaesthesia

Sherman and Chesebro highlight the need for regulation and accountability around decarbonising healthcare.1 Many hospitals, including my own, have withdrawn desflurane from circulation because of its contribution to greenhouse gases, resulting in a change in practice. Volatile gas consumption can further be reduced by using total intravenous anaesthesia, in which a combination of infused drugs, rather than inhaled gases, maintains anaesthesia. Currently, however, there is a national disruption to the supply of remifentanil, one of the main drugs needed for this technique. Trusts have been told to “preserve supplies of remifentanil use for priority indications,”2 to be agreed locally.Local contingency plans, to be actioned in the absence of remifentanil, propose the use of volatile anaesthesia. Patients rightly expect high quality anaesthesia and analgesia, and any regulatory framework must take the shortage of drugs required to continue to deliver anaesthesia into consideration.
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