The 5R approach | Association of Anaesthetists

The 5R approach

The 5R approach

The 5R approach study by Hutchings and White* shows steps specific to anaesthesia that we can all use to help combat climate change.


  • Choose paperless anaesthetic practice (electronic recording of notes, results, anaesthesia records, departmental communications)
  • Choose durable, upgradable anaesthetic equipment where possible
  • Buy equipment and drugs in bulk
  • Use rechargeable batteries and refillable ink cartridges
  • Use oral medications rather than intravenous preparations
  • Make sure sharps bins are full before disposal
  • Use small aperture sharps bins
  • Use large receptacles (e.g. sharps bins)
  • Only unpack equipment when it is needed
  • Consider whether equipment is actually needed (e.g. calf compressors, thermal blankets for short procedures)
  • Keep theatre temperature to a safe minimum
  • Turn off electronic equipment that isn't being used
  • Avoid the use of nitrous oxide
  • Use low flow anaesthesia
  • Consider regional rather than general anaesthesia
  • Avoid plastic bags for collecting dry waste


  • Reuse unpackaged but unused equipment if it is safe to do so
  • Wash and reuse plastic 'drawing-up' trays
  • Consider reusing low infectivity devices (e.g. pressure bags)
  • Drink from reusable cups, not plastic disposable cups
  • Advocate the use and reuse of metal sharps bins and waste containers, emptied into a central hospital collection point.
  • Advocate schemes where companies collect and refill used receptacles


  • Segregate potential recyclables - cardboard, paper, plastic, glass
  • Consult waste recycling firms about recycling waste, identifying hospital areas for compaction and collection


  • Redesign waste management in anaesthetic rooms, so that it is easier to recycle than to dispose
  • Ask supply managers to preferentially tender drug and equipment contracts based on companies' environmental credentials
  • Engage with hospital managers to develop 'greener' waste management policies
  • Organise staff training with regard to waste management
  • Take responsibility for the contents of recyclable waste


Encourage audits on the following:

  • Use of nitrous oxide
  • Use of low flow anaesthesia
  • Use of TIVA
  • Oxygen use/wastage
  • Correct drug disposal
  • Energy use
  • Single-use equipment use
  • Staff and equipment transport
  • Waste streaming and disposal/incineration
  • Paper use

And finally, encourage research in green anaesthesia practices.

*Adapted from BMJ 2009; 338: b609:

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