Sustainable anesthesia and environmental stewardship: balancing ecological responsibility with patient safety

PURPOSE OF REVIEW: This narrative review aims to summarize and assess recent research in sustainable anesthesia and patient safety. RECENT FINDINGS: Recent evidence characterizing volatiles as per- and polyfluoroalkyl substances, supports transitioning towards intravenous anesthesia where clinically appropriate. Potential ecotoxicity caused by propofol is minimal, and total intravenous anesthetic techniques are safe and effective. Reusable anesthetic equipment, such as laryngeal mask airways, breathing circuits, and patient warming devices, reduces greenhouse gas emissions and does not impact patient safety when proper sanitation protocols are followed. Virtual preoperative anesthetic consultations reduce greenhouse gas emissions, and recent randomized controlled trials found no difference in the accuracy of anesthetic assessment between virtual and in-person consultations. Finally, as extreme weather events continue to increase in frequency and intensity, we highlight the importance of climate-resilient systems in anesthesia. SUMMARY: New literature in sustainable anesthesia emphasizes the importance of transitioning to intravenous anesthesia, using reusable equipment such as patient warming devices, virtual preoperative anesthesia consultations, and climate resiliency.