‘Greening’ the operating room: Arash Motamed

USC Trojan Family Magazine is showcasing Trojans who have made a notable impact in sustainability at the University of Southern California.

For anesthesiologist Arash Motamed, the operating room is not just a venue for exceptional patient care. It also serves as an environment where minor adjustments can yield substantial advantages for the ecosystem.

In all aspects from the gases utilized to sedate patients to the tools used by surgeons and anesthesiologists, Motamed identifies opportunities to “green” the OR.

Motamed is Keck Medicine of USC’s inaugural medical director for sustainability, a role he officially started in December 2022. However, Motamed — who also serves as a clinical associate professor and vice chair for clinical operations in the anesthesiology department at the Keck School of Medicine of USC and medical director overseeing operating rooms at Keck Hospital of USC — had been leading sustainability projects long before he took on that position.

When USC President Carol Folt commenced her term in 2019, Motamed was thrilled by her commitment to reducing the carbon, water, and waste footprints across USC campuses. He pushed for the establishment of a role that would unify these initiatives from a clinical perspective at Keck Medicine.

Motamed’s sustainability achievements in the years that followed laid the groundwork for the position he now occupies officially. “I was able to define my own job description,” remarks Motamed, a triple Trojan holding degrees from the USC Dornsife College of Letters, Arts and Sciences, the Keck School of Medicine, and the USC Marshall School of Business.

A nature enthusiast, Motamed is driven by his concern for planet health and his passion for innovation. Analyzing patient care through the prism of sustainability “provides me the chance to reevaluate all that we engage in,” he states.

Eradicating harmful anesthetic gases

Motamed led Keck Medicine’s decision in December 2022 to eliminate desflurane, a frequently used but environmentally damaging anesthetic gas. In early 2021, he initiated an effort to phase out the potent greenhouse gas, which traps heat in the atmosphere and accelerates climate change. He promoted a transition to sevoflurane, an anesthetic that is less harmful to the
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environment, more economical and less troublesome to patient airways.

To facilitate the shift to sevoflurane, Motamed took out desflurane canisters from anesthesia machines at Keck Hospital and stored them in his office, where they were accessible to any anesthesiologist who filled out a sign-out sheet. “Over the coming months, only one individual came in and signed out desflurane,” Motamed states. “After that, no one ever returned. Hence, a year later, we instructed the pharmacy to remove it from the hospital’s list of authorized medications.”

Motamed subsequently directed his focus towards nitrous oxide, another prevalent anesthetic that exacerbates global warming and lingers in the atmosphere for about 100 years. In medical facilities, nitrous oxide is commonly delivered via a central pipeline that is susceptible to leaks. “Research indicates that potentially up to 93% of nitrous oxide may escape into the environment and doesn’t even reach the patient,” Motamed remarks.

Similar to the desflurane elimination approach, Motamed withdrew nitrous oxide and provided his colleagues with a contact number to request a nitrous oxide cylinder for their needs. “Within a few months, only one person made the call for it,” Motamed recounts.

In 2023, Keck Hospital became the pioneer in the nation to cease all usages of nitrous oxide in anesthesia practice. USC Norris Cancer Hospital followed suit in 2024.

Motamed also pursued a software enhancement for Keck Hospital’s anesthesia machines that includes a waste-saving mode for sevoflurane. Since its launch in fall of 2024, sevoflurane emissions have been reduced by approximately 50%. “We estimate this reduction in greenhouse gases to equate to driving around the Earth’s circumference about 10 times each year,” Motamed explains.

Enhancing collaboration, reducing waste

Although his efforts have prompted change, Motamed emphasizes that sustainability is not a “one-person endeavor.” He has fostered collaboration on sustainability enhancements by partnering with other sustainability leaders across USC’s campuses through the Keck USC Sustainability & Healthcare Initiative group and establishing the Keck OR Sustainability Team (KOST).

KOST — which comprises OR nurses, representatives from perioperative teams, surgeons, anesthesiologists, and surgical technologists — convenes monthly to explore methods for making operating rooms more sustainable and less wasteful. “Research indicates that around 20% of what we unpack in the operating room ultimately ends up in the trash without even contacting the patient,” Motamed states.

For instance, it was previously standard practice for anesthesiologists at Keck Hospital to utilize disposable handles for laryngoscopes, devices that enable them to insert a breathing tube into a patient. These plastic handles, each containing two batteries, were utilized for merely a few seconds before disposal. In September 2024, the hospital transitioned to reusable handles that can be sanitized. Motamed estimates that 5,000 single-use handles and 10,000 batteries have been saved from disposal since then.

Other waste-reduction initiatives spearheaded by the working group include turning off lights when operating rooms are unoccupied, limiting the disposal of inappropriate items in biohazard waste bins, and unwrapping surgical supplies from sterile packaging only when medically necessary.

Motamed aspires to cultivate a culture of sustainability in the OR through these cooperative endeavors. He aims to integrate sustainability “into everything we do, rather than having it be a separate faction trying to instigate change,” he says.

“I seek to establish connections and transform the culture to render myself essentially obsolete in this domain,” Motamed adds. “If I succeed in my capacity as medical director of sustainability, I won’t be doing this in a few years.”