The anaesthetist and the environment

As with all human endeavour, anaesthesia has an environmental impact: volatile anaesthetic agents vented into the atmosphere; propofol into the water; single use items (mainly plastic); water and electricity usage. As healthcare expands on a local as well as global level, we have a conflict: our progress is of undeniable benefit to patients, but at what cost to our planet and its inhabitants?

This editorial by Sneyd et al. began by reminding us that the Association of Anaesthetists ran two seminars in 2009 on ‘The anaesthetist and the environment’, involving ‘informed anaesthetists’ and external experts. “The conclusions were clear.... The Earth is in the midst of an environmental crisis, driven largely by human activity. In our work and personal lives, we all bear responsibility for this, and for the harm it causes to others.” They called for all in the profession to step up and make a difference to the climate emergency. So, did we? Yes and no.

“Anaesthetists are prolific users of disposable devices and particularly plastics, which clutter landfill, generate dioxin when incinerated and contain plasticisers with emerging health effects”, such as leaching of plastic degradation products into intravenous infusions with detrimental effects on the endocrine system. Plastics are a ubiquitous blight on our environment, and there seems to be no corner of our ecosystem left untouched; in 2020 microplastics were found in human placental tissue [1].

“The NHS has a carbon footprint of 18 million tonnes of carbon dioxide per year… (and) has increased its carbon footprint by 40% since 1990. This means that meeting the Climate Change Act targets of 26% reduction by 2020... will be a huge challenge.” There has been some improvement here. The NHS England Sustainable Development Unit reported an 18.5% reduction in CO ₂ emissions between 2007 and 2017 [2]. In January 2020 Sir Simon Stevens announced the ‘For a greener NHS’ campaign, with a commitment to become the world’s first health system to be carbon net zero [3]. The NHS Long Term Plan tasks anaesthesia with reducing the NHS acute sector's carbon footprint by 2% by ‘transforming anaesthetic practices’, and refers to reducing the use of single use plastics through improvements in the supply chain [4].

The scientific evidence for making environmentally-sustainable choices of anaesthetic technique is much improved using life cycle assessments [5]. Many anaesthetic departments have sustainability working groups, and anaesthesia organisations worldwide have advocacy statements on environmentally sustainable practices. Sneyd et al. noted the Association’s pledge on climate change effort, which included “… to examine and make public its own actions to produce meaningful and sustained reductions in greenhouse emissions from its buildings and activities.” Since then, the Association has formed its own Environment and Sustainability Committee, launched the joint Barema/Association Environment Award, and implemented greener initiatives in its headquarters and educational establishments [6]. The 2020 pandemic has massively decreased transport emissions as a result of all the virtual meetings and events, and these new models will be incorporated into future ways of working.

There is no doubt that the last 10 years have brought progress in environmental sustainability in anaesthesia, not least in awareness of the scale of the problem. I will leave you with the words of Sneyd et al.: “Time is pressing…and we face the abyss” . Damning reading indeed.

Naomi Freeman
Elected Member, Association of Anaesthetists Trainee Committee
ST7 Anaesthesia,
Royal Infirmary, Edinburgh

References 

1. Ragusa A, Svelato A, Santacroce C, et al. Plasticenta: first evidence of microplastics in human placenta Environment International 2021; 146: 106274. 
2. NHS Sustainable Development Unit. Natural resource footprint, 2018. https://www.sduhealth.org.uk/policy-strategy/reporting/natural-resource-footprint-2018.aspx (accessed 6/1/2021). 
3. NHS. For a greener NHS, 2020. www.england.nhs.uk/greenernhs/ (accessed 6/1/2021). 
4. NHS. NHS Long Term Plan, health and the environment, 2021. www.longtermplan.nhs.uk/online-version/appendix/health-and-the-environment/ (accessed 6/1/2021). 
5. McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. British Journal of Anaesthesia 2020; 125: 680-92. 
6. Association of Anaesthetists. Our environmental work, 2021. www.anaesthetists.org/Home/Resources-publications/Environment/Our-environmental-work (accessed 6/1/2021).

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