Sustainable anesthesiology: evidence-based strategies for environmental stewardship in perioperative care

The global healthcare sector accounts for approximately 4.4% of the total greenhouse gas emissions, with anesthesiology contributing disproportionately through volatile anesthetic agents whose global warming potentials range from 130 (sevoflurane) to 2540 (desflurane). This narrative review examines the environmental implications of contemporary anesthetic practice and evaluates evidence-based strategies for sustainable anesthesia delivery. Desflurane has a global warming potential approximately 20-fold greater than sevoflurane, making it the most environmentally damaging volatile anesthetic in clinical use. Total intravenous anesthesia (TIVA) produces substantially lower emissions at approximately 0.4 kg CO₂-equivalent/h, compared with 3.1-3.8 kg CO₂-equivalent/h for volatile-based techniques. Low-flow anesthesia techniques may reduce volatile agent consumption by 50-75% without compromising patient safety. Current evidence suggests that sustainable anesthesia practices can substantially reduce environmental impact while maintaining optimal patient safety. Strategies such as eliminating desflurane use, implementing low-flow techniques, and increasing TIVA utilization represent immediately implementable interventions with established safety profiles and demonstrated economic benefits. Implementation in diverse healthcare settings, including Asian contexts, requires tailored approaches considering regional practice patterns and resource availability.