Sustainable Anesthesia: A Scoping Review of Carbon Reduction Strategies

Anesthesia contributes substantially to healthcare-related greenhouse gas (GHG) emissions especially by inhalational agents such as desflurane, sevoflurane, nitrous oxide, relying on single-use equipment and having high energy demand equipment. Over the past decade, increased awareness of these impacts has led to growing research into sustainable anesthesia, exploring interventions such as low-emission techniques, equipment reuse, waste reduction, and workflow optimization. A scoping review was conducted according to PRISMA and PRESS guidelines. The databases Embase and MEDLINE were searched for studies (2010-2025) reporting on interventions to reduce anesthesia-related carbon footprint equivalents (CO2e). Eligible studies were prospective or retrospective in human patients and reported results in CO2e. Two reviewers independently screened and extracted data. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Of 3309 records identified, 33 studies met the inclusion criteria and were included in the synthesis. Five studies were rated as low quality. The included studies, conducted across ten countries, evaluated diverse sustainability interventions including nitrous oxide restriction, reduction or elimination of desflurane, promotion of total intravenous or regional anesthesia, optimization of fresh gas flows, equipment reuse, waste reduction, telemedicine, and departmental educational programs. Reported outcomes showed CO2e reductions ranging from 50% to over 90%, with some interventions achieving absolute savings of several tonnes CO2e per year. Our analysis shows that various strategies, including low-emission techniques, equipment reuse, waste reduction, and telemedicine, can significantly lower anesthesia-related CO2e without compromising patient safety. The greatest impact comes from combining behavioral, technical, and organizational measures, highlighting the need for a coordinated, system-wide approach.