Inhaled Anesthesia Climate Initiative and Research

By the American Society of Anesthesiologists, Environmental Task Force.

I. Reduce Inhaled Anesthetic Atmospheric Waste

• Utilize low fresh gas flows
• Avoid high impact inhaled anesthetics: Desflurane, Nitrous Oxide
• Consider intravenous and regional techniques
• Invest in WAG trapping (for volatiles only) or WAG destroying (all inhaled anesthetics, including Nitrous Oxide) technology for the Anesthesia Machine

II. Reduce IV Pharmaceutical Waste

• Use prefilled syringes
• Use appropriate sized vials for an individual patient
• Dispose of unused medications and vials according to regulations (and not exceeding)

III. Reduce Anesthesia Equipment Waste

• Only open equipment intended for immediate use
• Consider purchase of reusable or reprocessed equipment over disposable
• Reprocess or recycle suitable disposable equipment
• Adjust stock levels to minimize discarding expired items
• Reformulate prefabricated kits to eliminate unnecessary items
• Reformulate anesthesia supply carts to eliminate unnecessary items
• Donate expired or unused open equipment

IV. Solid Waste Segregation

• Segregate waste according to type (pharmaceutical, solid, biohazard, etc.)
• Avoid default of placing all waste into a biohazard or sharps bins
• Recycle batteries
• Consider intraoperative recycling program for clean plastics, paper and cardboard
• Use reusable sharps containers

V. Linens

• Consider reusable linens
• Minimize excessive use of reusable and disposable towels and blankets

VI. Electronics

• Avoid excess electronics without proven benefit to patient care
• Use a certified sustainable electronics recycling vendor to dispose of old equipment
• When negotiating equipment upgrades/contracts, request vendors take back old equipment for refurbishment and donation, or request vendor use a certified sustainable electronics recycling vendor

VII. Leadership

• Develop/join a Sustainability Committee at a department, hospital, or society level
• Become involved in environmental preferable purchasing
• Educate staff regarding the health, safety, and cost benefits of environmental projects
• Evaluate new equipment, facility, and behavior options for improved sustainability

• Watts N, Adger WN, Agnolucci P, et al. Health and climate change: policy responses to protect public health. Lancet 2015; 386(10006): 1861-914.
• Eckelman M, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health, PLoS ONE 2016;11(6) https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0157014
• Vollmer M, Rhee T, Rigby M, Hofstetter D, Hill M, Schoenenberger F, Reimann S. Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere. Geophys Res Lett 2015 March;42(5):1606-11
• Sherman J, Le C, Lamers V, Eckelman M. Life cycle greenhouse gas emissions of anesthetic drugs. Anesth Analg. 2012; May;114(5):1086-90
• Carbon Footprint from Inhaled Anesthetic Gases, National Health Service England and Public Health England, Sustainability Development Unit,
• Thiel C, Eckelman M, Guido R, Huddleston M, Landis A, Sherman J, Shrake S, Copley-Woods N, Bilec M.: Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States. Environ Sci Technol 2015;49:1779-1786
• Ryan S, Nielsen C. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010 Jul;11(1):92-8
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• Eckelman M, Mosher M, Gonzalez A, Sherman J: Comparative Life Cycle Assessment of Disposable and Reusable Laryngeal Mask Airways. Anesth Analg 2012; 114: 1067-1072
• McGain F, Jarosz K, Nguyen M, Bates S, O'Shea C. Auditing Operating Room Recycling: A Management Case Report. A A Case Rep 2015 Aug 1;5(3):47-50
• McGain F, Algie C, O’Toole J, Lim T, Mohebbi M, Story D, Leder K. The microbiological and sustainability effects of washing anaesthesia breathing circuits less frequently. Anaesthesia 2014 Apr;69(4):337-42
• Sherman J, Ryan S. Ecological responsibility in anesthesia practice. Int Anesthesiol Clin. 2010 Summer;48(3):139-51