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

Excerpt

“Can’t see the forest for the trees” aptly describes a conundrum the health sector is facing when it comes to environmental pollution. The World Health Organization (WHO) recognizes global warming as the number one threat to human health in the 21^st century. Yet the healthcare industry is one of the major contributors of greenhouse gas (GHG) emissions and hence directly contributes to the healthcare burden.1 The contribution of healthcare to atmospheric pollution is significant, as shown in a recent report on GHG emissions from Canada, which estimated the burden attributable to the health sector to be 4.6% of the national total, seeing a 10% increase between 2009 and 2014.1 In the United States of America, carbon dioxide (CO₂) emissions from the health sector have increased at a rate of 30% over the last decade.2 Not accounted for in these estimations are anesthetic gases, since they are not mandatorily reportable. The impact of inhalational anesthesia on the environment was explored by different authors over the last decade. While it is now well established that all of our inhaled anesthetic agents are GHGs of varying potencies, solutions to minimize their environmental impact have not been clearly formulated. With this background, an update of the topic to the current level of understanding and solutions to minimize the environmental impact are presented below. …