Re-defining the 3R’s (reduce, refine, and replace) of sustainability to minimize the environmental impact of inhalational anesthetic agents

“If I had a million dollars…”: The curious incident of a city, a forest, and sustainable anesthesia

“…Despite all the benefits of inhalational anesthesia, all currently used agents are potent greenhouse gases (GHG) and contribute to global warming. 2 Additionally, nitrous oxide is the most potent ozone-depleting agent in the atmosphere today. Edmontonbased members of the recently founded Section for Environmental Sustainability within the Canadian Anesthesiologists' Society (CAS-ES) planned to celebrate WAD by reforesting part of the Fort McMurray area with the number of trees necessary to offset one year of carbon dioxide equivalents (CDE) produced by volatile anesthetic agents used that year in the Edmonton zone.…”

Comparison of Propofol or Isoflurane Anesthesia Maintenance, Combined with a Fentanyl–Lidocaine–Ketamine Constant-Rate Infusion in Goats Undergoing Abomasotomy

“…When anesthesia is maintained exclusively with a single inhaled agent (i.e., in the absence of other sedatives or analgesics drugs), high doses of anesthetics are required to achieve a satisfactory anesthetic plane, which increases the likelihood of adverse effects (e.g., dose-related cardiovascular depression) [5]. In addition, the use of a single inhaled agent often requires expensive special equipment and installations for administration, and inhaled agents such as isoflurane, are chlorofluorocarbons, compounds potentially dangerous to the earth's ozone layer [6], and may contribute to global warming [7].…”

Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics

“…[2][3][4] Therefore, health professionals should be involved in the reduction of the carbon footprint related to their activity. 5 Several practice changes have been proposed for reducing greenhouse gas emissions in operating rooms, such as reducing waste from unnecessary medical devices, 6 choosing thoughtfully anesthetic drugs while taking into account their ecological impact, 7,8 reducing waste of drugs like propofol, 9 and reducing fresh gas flows to 0.5 L.min −1 , whenever possible. [10][11][12][13][14] In particular, optimizing the choice of inhaled anesthetics could lead to a substantial decrease in the carbon footprint related to anesthesia, as halogenated anesthetics can represent up to 50% of operating room total greenhouse gas emissions, 15 mainly due to desflurane.…”