• Greta Gasciauskaite, Justyna Lunkiewicz, Michael Tucci, Corinna Von Deschwanden, Christoph B Nöthiger, Donat R Spahn, and David W Tscholl.
• Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland. Electronic address: greta.gasciauskaite@usz.ch.
• Br J Anaesth. 2024 Dec 1; 133 (6): 144914581449-1458.

BackgroundAnaesthesia contributes substantially to the environmental impact of healthcare. To reduce the ecological footprint of anaesthesia, a set of sustainability interventions was implemented in the University Hospital Zurich, Switzerland. This study evaluates the environmental and economic implications of these interventions.MethodsThis was a single-centre retrospective observational study. We analysed the environmental impact and financial implications of changes in sevoflurane, desflurane, propofol, and plastic consumption over 2 yr (April 2021 to March 2023). The study included pre-implementation, implementation, and post-implementation phases.ResultsAfter implementation of sustainability measures, desflurane use was eliminated, there was a decrease in the consumption of sevoflurane from a median (inter-quartile range) of 25 (14-39) ml per case to 11 (6-22) ml per case (P<0.0001). Propofol consumption increased from 250 (150-721) mg per case to 743 (370-1284) mg per case (P<0.0001). Use of plastics changed: in the first quarter analysed, two or more infusion syringes were used in 62% of cases, compared with 74% of cases in the last quarter (P<0.0001). Two or more infusion lines were used in 58% of cases in the first quarter analysed, compared with 68% of cases in the last quarter (P<0.0001). This resulted in an 81% reduction in overall environmental impact from 3 (0-7) to 1 (0-3) CO2 equivalents in kg per case (P<0.0001). The costs during the final study phase were 11% lower compared with those in the initial phase: from 25 (13-41) to 21 (14-31) CHF (Swiss francs) per case (P<0.0001).ConclusionsImplementing sustainable anaesthesia interventions can significantly reduce the environmental impact and cost of anaesthesia.Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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