Toward a Greener Future in Pediatric Anesthesia
Why should pediatric anesthesiologists care about climate change? Because the operating room is one of healthcare’s biggest polluters—and anesthesia plays a key role. This podcast episode unpacks why rethinking pediatric anesthesia is not only an environmental imperative but also a clinical opportunity.
Based on the latest evidence—including research up to 2025—the discussion explores how volatile anesthetic gases like desflurane and nitrous oxide contribute disproportionately to global warming. In response, the episode highlights superior, patient-centered alternatives such as total intravenous anesthesia (TIVA) and EEG-guided monitoring, which reduce emissions while improving outcomes like less respiratory complications and improved postoperative recovery.
Listeners will also hear practical strategies: from switching to reusable materials to optimizing fresh gas flows—all aimed at making sustainability a new standard for safety and quality in pediatric care.
Yet, meaningful change requires more than knowledge—it demands shifts in behavior, institutional commitment, and overcoming implementation barriers within clinical practice.
Main references used in this podcast for discussion:
1. IPCC Sixth Assessment Report: Metrics
2. Sulbaek Andersen MP et al. Assessingthe potential climate impact of anaesthetic gases. Lancet Planet Health. 2023;7(7):e622-e629. doi:10.1016/S2542-5196(23)00084-0
3. Shen F, et al. Effect ofIntravenous, Inhalational, or Combined Anesthesia Maintenance on PostoperativeRespiratory Adverse Events in Children Undergoing Adenotonsillectomy (AmPRAEC): A Multicenter Randomized Clinical Trial. Anesthesiology.doi:10.1097/ALN.0000000000005707
4. Karam C et al. Respiratory adverse events after LMA® mask removal in children: A randomized trial comparing propofol to sevoflurane. Anesth Analg. 2023;136(1):25–33. doi:10.1213/ANE.0000000000005945
5. Miyasaka KW et al.EEG-Guided Titration of Sevoflurane and Pediatric Anesthesia Emergence Delirium: A Randomized Clinical Trial. JAMA Pediatr. Published online April 21, 2025. doi:10.1001/jamapediatrics.2025.0517
6. de Heer IJ et al. The Influence of Electroencephalographic Density Spectral Array Guidance of Sevoflurane Administration on Recovery From General Anesthesia in Children. A Randomized Controlled Trial. Paediatr Anaesth. 2025;35(4):287-293. doi:10.1111/pan.15065
7. Kalmar AF, et al. Environmental impact of propofol: A critical review of ecotoxicity and greenhouse effects. Best Pract Res Clin Anaesthesiol. 2025.10.1016/j.bpa.2024.12.003
8. Waspe J, Orr T. Environmental risk assessment of propofol inwastewater: a narrative review of regulatory perspectives. Anaesthesia. 2023;78:337–342. doi:10.1111/anae.15941
9. Karlsson SL, et al. Bacterial contamination and greenhouse gas emissions: reuse versus single-use infusion-set components for intravenous anesthesia. Eur J Anaesthesiol. 2024;41:910–920.
10. Kampman JM et al. The optimal mode of anaesthesia: are we ready for an evidence-based recommendation? Br J Anaesth. 2025. doi:10.1016/j.bja.2025.03.005
11. Kampman JM et al. Influence of nitrous oxide added to general anaesthesia on postoperative mortality and morbidity: a systematic review and meta-analysis. Br J Anaesth. 2024;133(6):1419–1426. doi:10.1016/j.bja.2024.02.011
12. Buhre W et al. The Glasgow Declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023;40(7):461–464. doi:10.1097/EJA.0000000000001862
13. Gonzalez-Pizarro P et al. European Society of Anaesthesiology and Intensive Care consensus on sustainability: Four scopes to achieve a more sustainable practice. Eur J Anaesthesiol. 2024;41(4):260–277.
doi:10.1097/EJA.0000000000001942
14. van Nieuwenhuizen KE et al. Evidence-Based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic Review. Ann Surg. Published online May 21, 2025.
