Green Surgery Report: Anaesthesia

Section Highlights

Local, regional, and intravenous anaesthetic techniques may be associated with lower carbon footprint, compared with inhaled anaesthetics.

Where inhaled anaesthetics are used, sevoflurane followed by isoflurane hold lowest global warming potential, and environmental impact can be further reduced through minimising fresh gas flows
Desflurane should not be used, bar exceptional circumstances.

Nitrous oxide is another powerful greenhouse gas, and emissions can be minimised through non-pharmacological methods to manage patient anxiety, decommissioning of centrally piped nitrous oxide (and substitution by portable cylinders), and nitrous oxide cracking technologies.

Pharmaceutical wastage can be reduced through only opening what is needed; all pharmaceutical waste should be disposed of appropriately.

There is currently a lack of robust evidence on capture rates of volatile capture technologies for anaesthetic gas waste.

Section Recommendations

(1) Opt for anaesthetic modality with lowest environmental impact (as clinically appropriate)

(2) Where inhaled anaesthetics are clinically necessary, avoid desflurane and minimise fresh gas flows

(3) Reduce nitrous oxide use and waste

(4) Minimise pharmaceutical wastage

Case Studies

Cold sticks for spinal/epidural blocks

Decommissioning nitrous oxide manifold

Local anaesthesia for inguinal hernia repair

_{*** Note: Outcomes data from case studies have not been verified and some financial and greenhouse gas emission figures are based on projections.}