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What you need to know• Sevoflurane and isoflurane have smaller atmospheric impacts than desflurane and nitrous oxide • Intravenous anaesthetic agents have minimal atmospheric impacts, but drug waste and urinary excretion of drugs and metabolites causes pollution in soil and ground water • Nitrous oxide is a common cause of medication waste and greenhouse gas emissions due to leaks in supply systems, over-ordering, and unused gas in cylinders returned to suppliers being vented to the atmosphere Case 1-A 30 year old woman attends the obstetric anaesthetic clinic at 36 weeks' gestation. This is her first pregnancy. The baby was in the breech position, and, after an unsuccessful attempt to turn the baby, she has been offered the option of planning for a vaginal delivery or a caesarean section. The anaesthetist discusses the anaesthetic and analgesic options for both and reassures the patient that all options appropriate to the mode of delivery are safe. Her priority is a safe delivery but she recently read online that both anaesthetic agents and "gas and air" contribute to global warming. Concern about the world in which her child will grow prompts her to ask which is the "greenest" option.Case 2-A 55 year old man is listed for total knee replacement for osteoarthritis, which is limiting his mobility and affecting his ability to pursue his passion for fell walking. When offered a choice of spinal or general anaesthesia, he says he has no preference providing both are safe, but he has noticed the enormity of hospital waste and asks which is the most sustainable option.