Providers can and should work toward 'sustainable anesthesia'

Anesthesia providers can and should begin taking steps toward practicing "sustainable anesthesia," according to the May special issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Anesthesiologists and other professionals have a duty to understand the environmental impact of anesthesia practice—including the "greenhouse gas" effects of anesthesia drugs, according to an introductory essay by guest editors Susan Ryan, PhD, MD, of University of California, San Francisco, and Jodi Sherman, MD, of Yale School of Medicine. They write, "As anesthesia providers…we need to add environmental stewardship to our list of exemplary contributions to medicine."

Special Issue Discusses Environmental Impact of Anesthesia…
Contributed by noted experts in the medical and other sciences, the nine articles in the special issue discuss key aspects of environmental sustainability in anesthesia practice. The goal is to introduce anesthesia providers to the complex issues involved in providing safe, high-quality patient care in a way that minimizes harmful effects on the environment—thus further reducing harmful effects on health.

A commentary by Dr Forbes McGain of Western Health, Victoria, Australia, and coauthors highlights the magnitude of carbon dioxide emissions related to anesthesia practice. "Annually worldwide, anesthetic gases are estimated to have the same global warming potential as one millions American passenger cars," the authors write. They also note that U.S operating rooms deposit more than 1,000 tons of solid waste into landfills every day—with anesthesia accounting for about one-fourth of the total.

In a survey study, Dr McGain and colleagues found that more than 90 percent of anesthesia providers agreed with the need to increase recycling in the operating room. However, only eleven percent said that recycling efforts were currently underway in their workplace.

How can anesthesia providers and hospitals act to lessen this waste and its environmental impact? Dr McGain and coauthors introduce the concept of life cycle analysis, which traces the impact of an item or process from manufacturing through disposal—"from the cradle to the grave."

…And How Providers Can Work Toward 'Sustainable Anesthesia'
While life cycle assessment is already being used in some sectors of the economy, it has received relatively little attention in health care, and surgery in particular. Three articles present life cycle assessments of anesthesia and OR products and practices. They illustrate that the issues affecting sustainability aren't always straightforward. For example, it may seem obvious that reusable supplies and equipment have a lower environmental impact than disposables—until one considers the environmental costs of water and energy used for cleaning and sterilization.

Some issues apply to many areas of medical practice, but others are specific to anesthesia. An article written by a team of atmospheric scientists discusses the global climate impact of different gases used for general anesthesia. Their paper provides the most recent data for determining the "ecological footprint" of various anesthesia drugs. Another article applies those data in a formal life cycle assessment, concluding that certain anesthetic gases—particularly desflurane and nitrous oxide—should be used only where they "would reduce morbidity and mortality over other anesthetic choices."

Other articles discuss approaches to waste reduction, focusing on minimizing waste of anesthetic gases. Some relatively straightforward strategies—such as "low-flow anesthesia"—can not only reduce environmental impact but also help to control costs.

Drs Ryan and Sherman hope the special issue will help anesthesia providers to start thinking about the environmental implications of what they do—while highlighting the many and complex factors that go into practicing anesthesia in an environmentally sustainable way. Dr Sherman comments, "It's our hope that, after reading the articles in our special collection, anesthesia providers will understand that it is their duty to know and do more to protect public health and safety through minimizing the ecological footprint in anesthesia practice."