Authors: Nadeem S et al.
Cureus 18(1): e101037. DOI: 10.7759/cureus.101037.
Summary
This narrative review argues that “green anesthesia” needs to move beyond low-flow techniques alone and tackle the larger, highly addressable waste stream generated around anesthesia care. Across multiple operating room (OR) waste audits and implementation reports, anesthesiology contributes a meaningful share of OR waste, and a large fraction of that material is clean (not patient-contaminated) and therefore potentially recyclable—but it is often misclassified into regulated medical waste (RMW), which is more expensive and environmentally intensive to process.
The authors highlight several high-yield, practical recycling targets that can be captured at the point of use with minimal workflow disruption: polypropylene blue wrap, IV fluid containers/bags (materials vary by product), rigid plastic basins/containers, flexible packaging, and paper/cardboard. Programs that combine clear signage, convenient bin placement at anesthesia workstations, and repeated staff education tend to improve sorting behavior and increase diversion away from RMW. Multiple institutional pilots described in the literature report substantial reductions in RMW volume, cost avoidance (driven by the higher disposal cost of RMW vs general waste), and occasional revenue from recyclable streams, suggesting that sustainability interventions can align with financial incentives.
In parallel, the review reinforces that inhaled anesthetics remain a major driver of anesthesia’s climate impact. It summarizes life-cycle findings that desflurane and nitrous oxide disproportionately contribute to greenhouse gas emissions, and that emissions can be reduced through low-flow delivery, preferential use of lower–global warming potential agents, reduced nitrous oxide use, and—where available—gas capture/mitigation technologies. The overarching message is that departments get the best “bang for the buck” when they run an integrated strategy: standardize low-flow and agent-selection practices while also building a reliable waste-segregation and recycling workflow, then track simple metrics (diversion and volatile use) to drive iterative improvement.
Key Points
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A large portion of anesthesia-adjacent OR waste is clean and potentially recyclable but is commonly discarded as RMW due to workflow barriers, unclear rules, and education gaps.
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High-yield recycling targets include blue wrap, IV containers/bags (depending on local recyclability), rigid plastics, flexible packaging, and paper/cardboard.
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Successful programs prioritize convenience (bins at the anesthesia station), simple signage, and repeated staff education, and often show cost avoidance by reducing RMW disposal.
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Volatile agent emissions remain a major climate lever; desflurane and nitrous oxide are emphasized as disproportionate contributors.
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Best results come from coupling waste-stream fixes with gas-focused changes (low-flow, agent selection, and gas capture when feasible) and tracking a small set of outcome metrics.
What You Should Know
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If you want a fast-start playbook: pick 1–2 “easy” recyclable streams (often blue wrap + clean paper/cardboard or selected plastics), place bins where anesthesia actually works, and use ultra-clear “what goes here” signage.
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Treat RMW reduction as a patient-safety–compatible workflow redesign problem (not a motivation problem): convenience and clarity are repeatedly cited as the biggest drivers of compliance.
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On the gas side, your biggest footprint reductions usually come from avoiding or minimizing high-impact agents and using reliably low fresh-gas flows—then consider capture tech if your facility supports it.
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Track a few metrics that leaders will understand: RMW per case, diversion rate for chosen materials, and use of high-impact volatiles/nitrous.
Thank you for allowing me to use this article from Cureus.