Sustainability and Green Anesthesia Practices: Environmental impact of anesthetics and eco-friendly protocols

The healthcare sector, while essential for human well-being, contributes significantly to global greenhouse gas (GHG) emissions, with anesthesia practices being a notable source due to volatile inhaled anesthetics and nitrous oxide (N₂O). This narrative review synthesizes literature from 2015 to 2025 on the environmental impacts of anesthetics, including their contributions to climate change, ozone depletion, and occupational health risks. Key findings highlight that inhaled anesthetics account for up to 50% of perioperative emissions in high-income countries, with desflurane exhibiting a global warming potential (GWP₁₀₀) over 2,500. Life cycle assessments reveal stark disparities among agents, emphasizing the need for sustainable alternatives. The review explores eco-friendly protocols, such as prioritizing low-GWP agents like sevoflurane, implementing low fresh gas flows (<1 L/min), shifting to total intravenous anesthesia (TIVA) or regional techniques, and adopting the 5Rs framework (reduce, reuse, recycle, rethink, research) for waste management. Technological innovations, including gas capture systems and end-tidal control, offer emission reductions of 68–75%, as demonstrated in systematic reviews and initiatives like the Green Anesthesia Initiative (GAIA). Challenges include resistance to change, limited awareness, and the need for standardized guidelines, but opportunities lie in education, policy advocacy, and industry collaboration. By embedding these strategies, anesthesia can align with net-zero goals, reducing costs and environmental burdens without compromising patient safety. Future research should focus on long-term outcomes and global implementation to foster greener practices.