Helping healthcare reduce its environmental footprint — starting where the opportunity is greatest
Carbon Stewardship Solutions is an anesthesiologist-led sustainability partner helping hospitals, ASCs, and health systems measure, reduce, and document their emissions — with unmatched real-world expertise in clinical anesthesia, healthcare’s single largest controllable emission source.
The challenge
Anesthesia is one of healthcare’s largest emission sources
Volatile anesthetic gases — especially nitrous oxide and desflurane — are potent greenhouse contributors. CMS estimates the healthcare sector’s emissions footprint could result in 250,000 deaths and $22 billion in costs by 2030.
Why act now
The regulatory clock is ticking
Regulatory landscape
The full spectrum of standards your facility needs to meet
Carbon Stewardship Solutions keeps you ahead of every major regulatory body — so your team can focus on delivering great patient care.
Professional society standards
Every major anesthesia society now calls for action
The professional bodies that govern anesthesia practice have all issued guidance calling for documented emissions reduction. This is no longer a fringe position — it is the standard of care.
ASA — American Society of Anesthesiologists
In 2024 the ASA published an updated Anesthesiology Sustainability Checklist emphasizing low fresh gas flows, avoidance of desflurane and nitrous oxide, and leadership roles in driving sustainability. The ASA's Committee on Environmental Sustainability runs the ongoing Inhaled Anesthetic 2025 Challenge and Greening the Operating Room initiative.
ASA — Inhaled Anesthetic 2025 Challenge
The ASA's active Inhaled Anesthetic 2025 Challenge benchmarks facility-level anesthetic carbon footprints through the Inhaled Anesthesia Climate Initiative in partnership with Project Drawdown. Participation demonstrates institutional commitment and provides comparative performance data — increasingly relevant to TJC certification and payer negotiations.
ASRA — American Society of Regional Anesthesia and Pain Medicine
ASRA's Green Anesthesia Special Interest Group — one of the earliest formal sustainability initiatives in U.S. anesthesia, since 2017 — actively promotes environmentally sustainable practice with a unique clinical angle: regional anesthesia and pain medicine techniques are positioned as the first consideration when developing an anesthetic plan, reducing reliance on inhaled agents. ASRA's published resources include guidance on redefining the 3R's (Reduce, Refine, Replace) for inhalational agents, propofol disposal, and the environmental case for total intravenous anesthesia.
APSF — Anesthesia Patient Safety Foundation
APSF has declared that sustainable healthcare must be the next patient safety movement — arguing that harm from healthcare-related pollution is equivalent in scale to the medical errors that originally sparked the patient safety movement. APSF specifically identifies nitrous oxide pipeline leakage (upwards of 70% of procured N₂O lost before reaching the OR) as both a patient safety and occupational safety issue, not just an environmental one. APSF offers a dedicated Low Flow Anesthesia course and multiple podcast episodes on sustainable healthcare practice.
AANA
In June 2024 the AANA issued formal policy considerations on the safe and effective disposal of waste anesthetic gases (WAGs), directing CRNAs to select agents with lower environmental impact, verify scavenging systems are in place, and stay current on technologies that reduce WAG venting. Applies to all practice settings including non-OR and office-based locations.
WFSA — World Federation of Societies of Anaesthesiologists
The WFSA's global consensus statement calls on all member societies to endorse the Anaesthesiology Environmental Sustainability Checklist. The ASA is a WFSA member society. Guidance targets reduction of inhaled anesthetic waste, desflurane elimination, and structured institutional reporting — aligning directly with CMS and TJC requirements.
NHS England — International precedent
As of April 1, 2024, NHS England became the first health system in the world to formally decommission desflurane due to its environmental impact — restricting it to cases where no clinical alternative exists. U.S. regulators and payers are watching closely. Early action now positions your facility ahead of similar U.S. mandates.
The emerging standard of care
27 national and international guidelines on sustainable anesthesia have been published between 2016 and 2024, with the majority issued since 2022. Real-world data shows a 54% reduction in anesthetic gas emissions achievable in year one of implementation — with desflurane down 63% and nitrous oxide down 64% — without compromising patient safety.
The method
A three-step path to emissions neutrality
Developed and personally validated by Dr. Hesler since 2020 in a real clinical setting, this three-step framework is applicable across healthcare emission sources — with anesthesia serving as our proven starting point.
Reduce
Convert from desflurane to sevoflurane and implement low-flow anesthesia (target: 1 LPM vs. 4 LPM national average). Avoid nitrous oxide when not clinically beneficial. Decommission leaking nitrous oxide pipelines.
Up to 80–90% of anesthesia emissions are preventable without compromising patient safety — with up to 97% cost savings per anesthetic hour.
Mitigate
Offset residual emissions that cannot safely be eliminated using selectively curated, high-integrity healthcare emissions offset credits sourced from audited U.S. regenerative agriculture operations.
Integrates regenerative agriculture-focused American family farms while sequestering greenhouse gases.
Document
CSS utilizes rigorous Carbon Accounting methods, thorough documentation, and quarterly reporting for regulatory compliance with CMS, ACHC, and TJC standards. Annual external compliance reports and peer-to-peer mentoring from practicing clinician peers are keys to success.
“It didn’t happen if you didn’t document it.”
Financial impact
Sustainability is a profitable decision
Emissions reduction directly improves your bottom line through cost avoidance, improved reimbursement, and physician retention.
Our founder
Pioneered by a practicing physician anesthesiologist
Every recommendation CSS makes has been personally vetted in the OR by Dr. Hesler — not just in a lab or on paper. Our focus is on delivering practical, achievable, real-world solutions where patient safety and clinician satisfaction are paramount.
Board-certified attending anesthesiologist with nearly 20 years of experience, Dr. Hesler has been practicing emissions-neutral anesthesia since 2020 — making him the first documented emissions-neutral anesthesiologist. His clinical experience intersected with his passion for regenerative farming, public health, and sustainable medicine and led him to develop the only real-world-tested, clinician-led model for emissions-neutral anesthesia.
Services
Comprehensive or targeted — your choice
Carbon Stewardship Solutions partners with hospitals, ASCs, and health systems to measure, reduce, and document emissions across the enterprise. Whether you’re looking for end-to-end sustainability support or targeted expertise in a specific area, we meet you where you are — with anesthesia as our flagship specialty and Carbon Accounting as our foundation.
Baseline assessment & Carbon Accounting
- Facility-wide and provider-level emissions baseline measurement and Carbon Accounting
- Institutional CO₂e reporting and Carbon Accounting documentation
- Quarterly Carbon Accounting reports for actionable clinician engagement
- Annual external compliance reports for regulatory bodies
EMR integration
- EMR-based data assessments to track emissions by department, service line, and provider in real time
- Live performance tracking with actionable metrics reporting
- Quarterly Carbon Accounting reports
- Integration with existing hospital EMR systems — no workflow disruption
Clinician & provider education and peer mentoring
- Succinct, easily completed education for all clinicians
- Peer-to-peer coaching and provider education from a practicing clinician with real-world sustainability experience
- Engagement with bedside clinicians, OR and practice managers, and C-suite executives
Supply chain responsibility
- Guidance on responsible sourcing of pharmaceuticals, medical supplies, and anesthetic agents to reduce supply chain emissions
- Strategies to reduce dependency on high-emissions products and agents vulnerable to supply chain disruptions
- Supply chain resilience planning
- Point-of-care nitrous oxide transition to eliminate pipeline waste and improve reliability
Emissions offset credit sourcing
- Curated healthcare-grade emissions offset credits only
- Sourced from audited U.S. regenerative agriculture operations
- Avoids greenwashing: no over-crediting, no double-counting
- Supports American family farms and rural sustainability
Regulatory compliance & documentation
- CMS, ACHC, and TJC compliance guidance
- Survey readiness: Carbon Accounting reports and policy development
- External compliance and institutional emissions reporting
- Medical gas system assessments and decommissioning coordination, including nitrous oxide pipelines
Creation stewardship
The deeper “why” behind what we do
For many in healthcare, the push toward sustainability goes beyond regulation and cost savings. It is rooted in a belief that we have an obligation to care for the natural world entrusted to us — and to leave it in better shape for those who come after. This conviction, drawn from our Christian belief in Creation Stewardship, is the driving force behind Carbon Stewardship Solutions.
Care for patients beyond the OR
Anesthesia’s environmental footprint affects the communities where our patients live. Reducing it is an extension of the commitment to patient well-being.
Stewardship of natural resources
We are caretakers — not owners — of the land, air, and water. Good stewardship means making decisions today that protect these resources for future generations.
Responsibility to future generations
What legacy are we leaving? The choices made in operating rooms today have consequences that extend far beyond the walls of any hospital.
“A good man leaves an inheritance to his children’s children.”
— Proverbs 13:22
Ready to lead your hospital, ASC, or health system toward a more sustainable operation?
Carbon Stewardship Solutions works with individual clinicians, anesthesia groups, and healthcare systems. All methods are patient-safe, clinician-tested, and cost-effective.