Search

The dedication of the international anaesthetic community to reducing the environmental impact of healthcare is important and to be celebrated. When this is underpinned by robust science, it has the potential to make a real difference. However, volatile anaesthetic agents have been widely promoted in the medical literature as damaging to the climate, leading to a drive to remove them from clinical practice. This is based on notional 'CO 2 -equivalent' values created using the simple emission metric known as the global warming potential. Here, we assert that when proper consideration is given to the science of climate change, volatile anaesthetic gas emissions cannot be simply equated to real carbon dioxide emissions, and that their climate impact is vanishingly small. This paper gives anaesthetists a framework to make informed choices founded on climate science and calls for attention to be refocused on the urgent need to reduce the real carbon dioxide emissions associated with healthcare., (© 2024 Association of Anaesthetists.)

Summary: The Earth's mean surface temperature is already approximately 1.1°C higher than pre‐industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three‐stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high‐, middle‐ and low‐income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re‐evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references. [ABSTRACT FROM AUTHOR]

Importantly, there was consensus (> 75%) that anaesthesia providers should: " I Use environmentally preferable medications and equipment when clinically safe to do so i " (principle 2) and " I Minimise the overuse/waste of medications, equipment, energy and water i " (principle 3). Although there is an ethical argument in favour of using regional anaesthesia ahead of TIVA ahead of inhalational anaesthesia, particularly within the "triple bottom line" performance framework of social, financial and environmental accountability, in practice anaesthesia providers need to continue minimising the environmental impact of their clinical practice, regardless of the method of anaesthesia used [[6]]. Keywords: anaesthetics, intravenous; climate change; environmental pollutants; propofol EN anaesthetics, intravenous climate change environmental pollutants propofol 282 287 6 02/08/23 20230301 NES 230301 Adapting to the adverse effects of climate change becomes considerably more difficult above a mean global surface temperature rise of 1.5°C above pre-industrial levels [[1]], particularly as 1.1°C of that warming has already occurred [[2]]. There was agreement without consensus (68%) that " I When feasible, anaesthetists should prioritise giving regional anaesthesia before total intravenous anaesthesia (TIVA) before inhalational anaesthesia, for environmental reasons i ". [Extracted from the article]