Environmental impact of anesthetic gases

FactsHealthcare systems negatively impact the environment, and the operating room is a major contributor.Inhalational anesthetics contribute to hospital greenhouse gas emissions.Understanding the pharmacology and clinical applications of commonly used anesthetic gases allows for meaningful discussion of environmental impact mitigation strategies, balanced with quality patient care.Open QuestionsWhat are the commonly accepted definitions of low flow anesthesia and how can they be implemented clinically?How can we best quantify the environmental impact of anesthetic gases and hypnotic agents in total intravenous anesthesiaWhat are available strategies to mitigate the detrimental effects of anesthetic gases to the environment? Healthcare systems are known to negatively impact the environment, with the operating room significantly contributing to these issues. Specifically, anesthetic gases have been a recent target of many sustainability initiatives, as they are known to be greenhouse gases and have traditionally been a cornerstone of providing general anesthesia. This review focuses on the current literature regarding the impact of anesthetic gases on the environment, including common definitions such as global warming potential and carbon dioxide equivalents. The most commonly used anesthetic gases are reviewed, including their impact on the atmosphere, as well as strategies to reduce their negative impact while maintaining their availability for use in the practice of anesthesiology. Specifically, the clinical applications of the commonly used anesthetic gases, namely sevoflurane, desflurane, isoflurane and nitrous oxide are discussed. This review further identifies and explores alternative methods that help mitigate the negative environmental impact of anesthetic gases, including gas capturing systems, low flow anesthesia and total intravenous anesthesia, as well as barriers to implementing these strategies. We conclude that while many strategies exist to minimize the environmental impact of anesthetic gases, implementation is often hindered by factors such as institutional buy-in and cost/return on investment ratio.