Guide to green anaesthesia
There are two areas where anaesthetists can make a practical contribution towards tackling climate change. Many will already be taking steps in their personal lives to reduce their impact on the environment. The same principles apply to conducting their professional lives.
The greatest impact for many will come from reducing their use of anaesthetic gases with significant global warming potential – in particular desflurane and nitrous oxide.
We suggest:
- Avoid nitrous oxide whenever possible, and use oxygen/air as the carrier gas; the effect of the increased use of volatile agent to achieve an adequate depth of anaesthesia is more than offset by the benefit of eliminating nitrous oxide
- Avoid use of desflurane except where specific clinical exceptions have been defined, refer to statement from NACCS
- Use low flow anaesthesia (max 1.5 l/min) during maintenance in all cases
- Consider swapping volatile agent-based anaesthesia for a TIVA technique
- Consider use of central neuraxial block or regional anaesthesia
An excellent article in the BMJ* provided 10 practical actions for all doctors interested in combating climate change:
- Inform yourself about the basic science of climate change, the health benefits of taking action, and the urgency of doing so
- Advise your patients. Better diet and more walking and cycling will improve their health and reduce their carbon emissions
- Save energy and money through house insulation, turning off appliances and lights and reductions in use of goods and services
- Drive and fly less, walk or cycle more, teleconference/webcast
- Eat local food, less meat, and less processed food - a low carbon diet is a healthy diet. Drink tap water
- Advocate locally
- Agitate for personal carbon entitlements and financial incentives to reduce carbon costs
- Advocate population stabilisation, by promoting literacy and promoting women’s access to birth control, via the International Planned Parenthood Federation or Marie Stopes International.
- Advocate a climate change agenda at all meetings
- Ally yourself with other health professionals
*Adapted from BMJ 2008; 336: 1507:
In February 2020 we published an issue of Anaesthesia News themed on the environment.
You can also find more information at the NHS Sustainable Development Unit website.