Effects of departmental green anaesthesia interventions on carbon dioxide equivalent emissions: a systematic review

Anaesthesia contributes to greenhouse gas emissions and can play a crucial role in reducing the carbon footprint of the global healthcare sector. The aim of this systematic review is to identify which departmental interventions influence estimated carbon dioxide (CO₂) equivalent emissions of anaesthesia and to quantify their reductions.

A systematic literature search was conducted through four major electronic databases (Cochrane Library, Embase, MEDLINE, and PubMed) for studies investigating the changes in CO₂ equivalent emissions per anaesthetic before and after departmental green anaesthesia interventions. Data were extracted by two independent reviewers. The primary outcomes were mean decrease of CO₂ equivalents in kilograms per anaesthetic and total decrease in CO₂ equivalents in tonnes. The mean effect was calculated as percentage change per patient and in total.

Of 3987 screened studies, 13 met the criteria for quantitative synthesis and showed low to moderate risk of bias. The following types of departmental sustainability interventions were found: education of staff, decreased use of desflurane and sevoflurane, promotion of TIVA, use of low fresh gas flows, proper waste management, and formation of green teams. The postinterventional total mean decrease of CO₂ equivalents in kilograms per anaesthetic was 68.2% (18.6%) and in total tonnes was 75.2% (16.3%).

Our analysis demonstrates the substantial CO₂ reduction potential inherent in sustainable anaesthesia programmes. Currently available literature supports staff education on avoidance of desflurane, reduction of volatile anaesthesia, lower fresh gas flow, increased utilisation of TIVA, and implementation of proper waste management protocols in operating rooms as potentially effective interventions.