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Summary: 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 'CO2‐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. [ABSTRACT FROM AUTHOR]

The life-cycle assessments of different preparations of the same drug are likely to be significantly disparate, but this is not always easy to demonstrate because a detailed life cycle assessment requires a dedicated research team and a significant amount of time. We read with great interest the review discussing the equivalence in efficacy between intravenous and oral administration of paracetamol in the peri-operative period [1]. When full, formal life cycle assessments of different preparations of paracetamol become available, we will be able to assess the "triple bottom line", which looks at patient benefit, cost and environmental impact. [Extracted from the article]