Waste-reduction culture, elimination of anesthetic gases slash OR emissions at USC

Editor's Note

A physician-led sustainability initiative focused on waste reduction and eliminating desflurane an nitrous oxide is paying off for Keck Medicine of the University of Southern California (USC), according to a May 19 report in USC Trojan Family Magazine.   

The article, part of a series focused on waste reduction throughout the university, focuses on anesthesiologist Dr. Arash Motamed’s efforts to merge clinical leadership with environmental stewardship. In his role as Keck Medicine’s first medical director of sustainability, Motamed has spearheaded a series of interventions aimed at reducing the carbon, water, and waste footprints of the health system—particularly within perioperative services. He began shaping the program before officially assuming the role in December 2022.

A key early move involved eliminating desflurane, a widely used anesthetic gas with a high global warming potential. Motamed began phasing it out in early 2021 by removing canisters from machines and requiring sign-out for use. After months of near-total disuse, the gas was removed from the hospital’s medication list, the outlet reports. He followed a similar approach with nitrous oxide, which is prone to leaking from central pipelines and contributes significantly to atmospheric warming. By 2023, Keck Hospital had eliminated nitrous oxide entirely; USC Norris Cancer Hospital followed in 2024.

In addition to changing what gases are used, Motamed worked with vendors to install software upgrades on anesthesia machines that reduce waste of sevoflurane—a less harmful alternative—by about 50%. According to the outlet, that reduction is equivalent to eliminating emissions from driving around the planet 10 times annually.

The effort extends beyond anesthesia. Motamed established the Keck OR Sustainability Team (KOST), a multidisciplinary working group that includes perioperative nurses, surgical technologists, anesthesiologists, and surgeons. Together, they’ve launched initiatives such as switching to reusable laryngoscope handles—eliminating roughly 5,000 single-use handles and 10,000 batteries annually—and reducing packaging waste by opening surgical items only when needed. Additional measures include turning off lights in unused ORs and minimizing misuse of biohazard bins.

As detailed in the article, Motamed emphasizes that sustainability must be embedded into everyday decision-making rather than delegated to a side initiative. His goal is to build a culture where sustainable practices are second nature and his own leadership role in the space becomes obsolete.