Appendix A. Vaporizer Labels

Desflurane Label

Sevoflurane Label

Scannable Quick Response Code (QRC) label

This QRC is a smart link to the following open-access website: http://anesthesia.wisc.edu/green,

which maintains a collection of downloadable literature (PubMed links) to pertinent

sustainability articles.

Appendix B. Carbon Dioxide Equivalency (CDE) and Cost Calculations FY 2012 versus FY

2015

No changes in decimal places were made in when calculating using the reported agent density.

During calculation steps, all numbers were limited to two places after the decimal (less if there

were no further places). The final results reported in the article text are rounded to whole

numbers.

Volatile agent purchased FY 2012:

Agent

(bottle

volume)

Number

of

Bottles

ml agent Density

(g/ml)

kg agent GWP100 CDE

(kg x GWP)

% total for

2012

Desflurane

(240 ml):

3025 726,000 1.465 1063.59 2540 2,701,518.6 57.19

Isoflurane

(100 ml):

416 41,600 1.496 62.23 510 31,739.14 0.67

Sevoflurane

(250 ml):

3142 785,500 1.5195 1,193.57 130 155,163.74 3.28

Total = 2,888,421.48 61.14

Nitrous oxide purchased FY 2012:

Cylinder

size

Number of

cylinders

lbs agent kg agent GWP100 CDE

(kg x GWP)

% total for

2012

56 lbs 241 13,496 6,134.54 298

E (7 lbs) 8 56 25.45

20 lbs 0 0 0

Total = 13,552 6,160 1,835,680 38.86

CDE total for 2012: volatiles + nitrous oxide = 4,724,101.48 kg

CDE per case for 2012: 4,724,101.48 ÷ 28,957 cases in FY 2012 = 163.14 kg

Volatile agent purchased FY 2015:

Agent (bottle

volume)

Number

of

bottles

ml agent Density

(g/ml)

kg agent GWP100 CDE

(kg x GWP)

% total

for 2015

Desflurane

(240 ml):

1354 324,960 1.465 476.07 2540 1,209,208.66 65.06

Isoflurane

(100 ml):

407 40,700 1.496 60.89 510 31,052.47 1.67

Sevoflurane

(250 ml):

3663 915,750 1.5195 1,391.48 130 180,892.68 9.73

Total = 1,421,153.81 76.46

Nitrous oxide purchased FY 2015:

Cylinder size Number of

cylinders

lbs agent kg agent GWP100 CDE

(kg x GWP)

% total for

2015

56 lbs 54 3024 1375

298E (7 lbs) 18 126 57

20 lbs 4 80 36

Total = 3230 1468 437,518 23.54

CDE total for 2015: volatiles + nitrous oxide = 1,858,671.81 kg

CDE per case for 2015: 1,858,671.81 ÷ 31,779 cases in FY 2015 = 58.48 kg

Total difference in CDE: 4,724,101.48 kg - 1,858,671.81 kg = 2,865,429.67 kg

Difference in CDE per case from 2012 to 2015: (163.14 - 58.48) = 104.66 kg

Reduction in CDE from 2012 to 2015: (104.66÷163.14) x 100 % = 64.15 %

Cost calculations

Agent Average bottles purchased per month in2012

Cost range per bottle (and average)*

2012

Average bottles purchased permonth in 2015

Cost range per bottle (and average)*

2015

Monthly change

Desflurane 252 $140-150 ($145) 112 $140-150 ($145) - $20,300

Sevoflurane 262 $100-110 ($105) 305 $70-80 ($75) - $4,635

Isoflurane 35 $7-11 ($9) 34 $4-8 ($6) - $111

Total savings - $25,046

* Our purchasing department will not allow publication of the exact cost (purchasing

negotiations), but will allow a range and estimated savings. See Figure 1 for numbers of bottles

of desflurane and sevoflurane purchased.

ns CO2E /vehicle/year = 613 passenger vehicles driven for one year

Appendix C. Waste Survey

Email to all clinical anesthesia providers (faculty, residents, anesthetists):

Subject: 3 quick questions

Dear Colleagues,

Several people have approached me since the last waste update with comments and

thoughts on waste reduction. This is great! I have come up with 3 brief (yes/no/select) questions

to ask you that may help us figure out how to be less wasteful as a group. I'd be very interested to

see what you think, here's the link: link

Thank-you!

Karin

Department demographics:

81 physician anesthesiologists

70 clinical anesthetists

52 residents

= 203 total members

97 respondents to survey = 47.8 % response rate

Appendix D. Hospital Type and Scope of Practice

UW Health is the integrated health system of the University of Wisconsin–Madison. UW Health

consists of 6 hospitals and 80 outpatient sites. The University Hospital and the connected

American Family Children’s Hospital (AFCH) make up a 592-bed academic medical center. It is

a designated level-one adult and pediatric trauma center, and has 6 intensive care units (trauma

and life support, pediatric, cardiac, cardio-thoracic, burn and neurosurgery). 31,779 anesthetics

were performed in fiscal year (FY) 2015 at our institution. These procedures are performed in the

adult inpatient operating suite with 27 rooms, an attached outpatient surgery center with 9 rooms

and an attached children’s hospital with 7 rooms; as well as non-OR anesthesia cases (NORA).

The fiscal year data for our case numbers are detailed in here.

Anesthetic case numbers per location for fiscal year (FY)

Location Cases in FY 12

(7/7/12-6/30/13)

Cases in FY 15

(7/7/15-6/30/16)

Inpatient OR 12,816 14,069

Outpatient OR 8,818 9,403

AFCHa 5,160 5,774

NORAb 2,163 2,533

Total 28,957 31,779

aAFCH: American Family Children’s Hospital

bNORA: Non-OR Anesthesia

Appendix E. Environmental Protection Agency (EPA) Greenhouse Gas Equivalency

Calculations

For a given CO2 amount, the online calculator available at: https://www.epa.gov/energy/ghg-

equivalencies-calculator-calculations-and-references provides equivalent greenhouse gas

emissions in concrete terms, such as the number of passenger vehicles on the road, according to

the following formula:

8.89 × 10-3 metric tons CO2/gallon gasoline burned × 11,443 vehicle miles traveled car/truck average ×

1/22.0 miles per gallon car/truck average × 1 CO2, CH4, and N2O/0.989 CO2 = 4.67 metric tons

CO2E/vehicle/year

Emissions equivalency example for our calculated CDE reduction: 2,865 metric tons CO2/4.67

metric tons CO2E /vehicle/year = 613 passenger vehicles driven for one year