Carbon footprint of general, regional, and combined anesthesia for total knee replacements
Open accessAbstract
Background: Health care itself contributes to climate change. Anesthesia is a “carbon hotspot,” yet few data exist to compare anesthetic choices. The authors examined the carbon dioxide equivalent emissions associated with general anesthesia, spinal anesthesia, and combined (general and spinal anesthesia) during a total knee replacement. Methods: A prospective life cycle assessment of 10 patients in each of three groups undergoing knee replacements was conducted in Melbourne, Australia. The authors collected input data for anesthetic items, gases, and drugs, and electricity for patient warming and anesthetic machine. Sevoflurane or propofol was used for general anesthesia. Life cycle assessment software was used to convert inputs to their carbon footprint (in kilogram carbon dioxide equivalent emissions), with modeled international comparisons. Results: Twenty-nine patients were studied. The carbon dioxide equivalent emissions for general anesthesia were an average 14.9 (95% CI, 9.7 to 22.5) kg carbon dioxide equivalent emissions; spinal anesthesia, 16.9 (95% CI, 13.2 to 20.5) kg carbon dioxide equivalent; and for combined anesthesia, 18.5 (95% CI, 12.5 to 27.3) kg carbon dioxide equivalent. Major sources of carbon dioxide equivalent emissions across all approaches were as follows: electricity for the patient air warmer (average at least 2.5 kg carbon dioxide equivalent [20% total]), single-use items, 3.6 (general anesthesia), 3.4 (spinal), and 4.3 (combined) kg carbon dioxide equivalent emissions, respectively (approximately 25% total). For the general anesthesia and combined groups, sevoflurane contributed an average 4.7 kg carbon dioxide equivalent (35% total) and 3.1 kg carbon dioxide equivalent (19%), respectively. For spinal and combined, washing and sterilizing reusable items contributed 4.5 kg carbon dioxide equivalent (29% total) and 4.1 kg carbon dioxide equivalent (24%) emissions, respectively. Oxygen use was important to the spinal anesthetic carbon footprint (2.8 kg carbon dioxide equivalent, 18%). Modeling showed that intercountry carbon dioxide equivalent emission variability was less than intragroup variability (minimum/maximum). Conclusions: All anesthetic approaches had similar carbon footprints (desflurane and nitrous oxide were not used for general anesthesia). Rather than spinal being a default low carbon approach, several choices determine the final carbon footprint: using low-flow anesthesia/total intravenous anesthesia, reducing single-use plastics, reducing oxygen flows, and collaborating with engineers to augment energy efficiency/renewable electricity. Editor’s Perspective: What We Already Know about This Topic: What This Article Tells Us That Is New:
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For spinal anesthesia, emissions were mainly dominated by electricity consumption for oxygen use and cleaning reusable equipment.
“For spinal anesthesia, the emissions were mainly dominated by the electricity consumption for oxygen use and cleaning the reusable equipment.”
From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [76]
Switching from the Australian grid to the European grid decreases the carbon footprint of spinal anesthesia by 40%.
“Switching from the Australian grid (mix mainly dominated by fossil energies) to the European grid (with a larger proportion of renewable energies) decreases the carbon footprint of spinal anesthesia by 40%.76”
From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [76]
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“to the European grid (with a larger proportion of renewable energies) decreases the carbon footprint of spinal anesthesia by 40%.(76) These continental differences stress the importance of defining full life-cycle assessments for different anesthetic approaches in different regions.”
Background
- Authors
- McGain, F., Sheridan, N., Wickramarachchi, K., Yates, S., Chan, B., & McAlister, S.
- Affiliations
- The University of Sydney (AU)
- Australian and New Zealand College of Anaesthetists (AU)
- The University of Melbourne (AU)
- Corresponding author
- McGain, Forbes
- Venue
- Anesthesiology
- Published
- 2021-09-16
- Volume
- 135
- Issue
- 6
- Pages
- 976-991
- ISSN
- 0003-3022 (ISSN-L)
- 1528-1175
- OpenAlex
- W3201556185
- Cited by
- 144
- References
- 39
- Citations by year
- 2026: 17 · 2025: 32 · 2024: 37 · 2023: 31 · 2022: 25 · 2021: 2
- FWCI
- 7.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Anesthesiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
- Keywords
- carbon footprint, total knee arthroplasty, general anesthesia, spinal anesthesia, combined anesthesia, CO2 equivalent emissions, life cycle assessment, sevoflurane, propofol, single-use medical devices, low-flow anesthesia, total intravenous anesthesia, oxygen consumption
- MeSH terms
- Anesthesia, Conduction, Anesthesia, General, Carbon Dioxide, Combined Modality Therapy, Humans, Nitrous Oxide, Prospective Studies, Victoria, Anesthetics, Inhalation, Arthroplasty, Replacement, Knee, Carbon Footprint
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