Initiatives to broaden safety concerns in anaesthetic practice: The green operating room

Study Type & Method: Narrative Review


  • Operating rooms (ORs) account for 70% of hospital waste with 25% of OR waste attributable to anaesthesia
  • 5R’s = reduce, reuse, recycle, rethink, research
  • A 50/50 mix of N2O/O2 at FGF of 1L/min releases 53.2 g of N2O/h = driving a European car for 120 km.
  • In the ORs not using desflurane, anaesthetic gases contributed to 4% of greenhouse gas (GHG) emissions. Conversely, in the ORs using desflurane, halogenated gases accounted for 51-63% of GHG emissions.
  • In a life cycle assessment, the environmental impact of propofol was nearly four orders of magnitude lower than that of desflurane or nitrous oxide.

Commentary: For environmentally-conscious anaesthetists, approach waste management systemically (i.e., 5R’s & life-cycle analyses) and use TIVA where clinically permissible.

Reviewed by Dr Philip Cheung