Sustainability in Action: Committee Priorities, National Progress, and Emerging Initiatives 

Sustainability is now firmly established as a shared priority across healthcare systems, and anaesthesia has a particularly important role to play. From the environmental impact of anaesthetic gases to the use of single-use equipment and energy-intensive operating theatres, and more recently, rethinking eco-designed care pathways, our specialty is uniquely positioned to make meaningful, measurable change. Over the past year, momentum has continued to build through the work of the ESAIC Sustainability Committee, the growing network of NASC Sustainability Ambassadors, and national initiatives, particularly those led by the French national society (SFAR). This update highlights current aims, realised and planned projects, and programmes of interest shaping the next phase of sustainable anaesthesia. 

The ESAIC Sustainability Committee: Aims and Strategic Direction 

The Sustainability Committee was established after 2018 to provide leadership, coordination, and practical guidance on reducing the environmental impact of anaesthesia, intensive and peri-operative care. Its overarching aim is to position anaesthesiology as the leading medical specialty in sustainability in hospital care and embed sustainability into everyday clinical practice while maintaining the highest standards of patient safety, quality, and equity. 

A key focus of the committee is practical implementation. While awareness of climate and environmental issues is increasing, clinicians often report uncertainty about how to translate good intentions into action. The committee therefore prioritises clear, evidence-based recommendations that can be applied at the departmental and institutional levels. We want to lead by example by enhancing sustainability in the ESAIC’s own operations, such as communicating its own environmental footprint. 

Another central aim is awareness through education. By supporting the development of educational resources and the use of accessible, attractive communication to increase awareness of sustainability and sustainable solutions, the committee seeks to ensure that sustainability becomes a routine consideration for anaesthesiologists at all career stages. This includes raising awareness of the environmental impact of anaesthetic agents, equipment choices, energy use optimisation, and peri-operative pathways. 

Another important area of work is training and professional development. The committee is exploring opportunities to integrate sustainability into continuing professional development activities, with a longer-term ambition of embedding environmental stewardship into anaesthesia training programmes. This reflects growing recognition that sustainability is a core professional competency rather than an optional interest. 

The committee also aims to support research. Understanding environmental impact is a prerequisite for improvement. We identify knowledge gaps, contribute to relevant research agendas, and coordinate the writing of position papers and review papers. We encourage the use of standardised metrics and audit tools to allow departments to track progress, compare outcomes, and integrate sustainability into existing quality improvement frameworks. In 2025, the first BJA-ESAIC Grant on environmental sustainability was launched.  

Finally, collaboration underpins all committee activities. Sustainability challenges community building across institutional and national boundaries, and shared learning is essential. The committee works closely with national societies, hospital sustainability teams, industry partners, medical organisations outside anaesthesiology/ICU, and policy and decision-makers at national and international levels to facilitate knowledge exchange on sustainability practices, align efforts, and amplify impact. 

Sustainability Committee achievements and current work: 

In 2023, ESAIC published its guidelines in “the consensus document on sustainability” [i]. A total of 90 recommendations covering four areas (gas, energy, waste, and society) were drafted by 13 sustainability experts in anaesthesia. 36 experts from 24 different countries then validated these in a two-step Delphi Validation.  

The same year, the Glasgow Declaration on Sustainability in Anaesthesiology and Intensive Care[ii]was officially signed at the Euroanaesthesia Congress in Glasgow. Based on the guidelines, the declaration serves as a roadmap for sustainable development in anaesthesiology and intensive care. 

The declaration was then endorsed by several National Societies at the Euroanaesthesia Congress in Munich in 2024, with formal signatures during the Congress. SFAR was the first! So far, 25 National Societies and the Spanish Government have endorsed the declaration (confirmed the numbers with Arta).  

In 2025, the ESAIC Sustainability Committee updated the toolkit for starters on the topic[iii]. 

This is a centralised collection of practical tools, guidance documents, and case studies that departments can adapt to their local context. Topics covered include direct emissions (inhaled anaesthetics), waste management and supply chain, energy consumption optimisation, wellbeing, and improving personal care. 

Several other planned projects aim to translate this strategy into concrete results. One of the committee’s priority initiatives is based on a consensus document on sustainability and intensive care (Mitigation Strategies in Intensive Care Medicine – ESAIC Consensus Document). 

This consensus document, to be published shortly, focuses on strategies to reduce the carbon footprint and environmental pollution associated with intensive care medicine. It is based on 17 recommendations initially drafted by four thematic groups – (1) energy, (2) waste management, (3) medicines, (4) ethics – and has been validated through a Delphi process. 

The committee’s second priority is the N₂O project (position paper and survey on the use of nitrous oxide), which aims to understand how nitrous oxide is used in clinical settings, identify avoidable losses due to leaks or inefficiencies, and reduce unnecessary consumption by moving away from centralised piping systems in several centres. The survey was conducted at the end of 2025 and collected 1,005 questionnaires. The final analytical cohort consisted of 732 anaesthesiologists from 64 countries, 82% of whom were European. Analysis of the survey is ongoing, and the results will be published as a supplement to the 2023 survey published by the ESAIC Sustainable Development Committee [iv], which describes the factors influencing the implementation of sustainable anaesthesia strategies among the ESAIC anaesthesiologists.  

Sustainability Ambassadors: Building a Network of Change 

A cornerstone of the committee’s work is the expanding network of National Societies’ Sustainability Ambassadors. Sustainability Ambassadors play a variety of roles. They raise awareness among colleagues, lead or support local audits, and act as points of contact between National Societies and the Sustainability Committee. Crucially, they also provide feedback on real-world challenges, ensuring that proposed initiatives remain feasible and clinically appropriate. 

Looking ahead, several next steps are under consideration to strengthen the ambassador’s programme. These include clearer role definitions, improved access to shared resources, and opportunities for ambassadors to connect and learn from one another through online forums, dedicated meetings, or an online platform for knowledge exchange. Developing a sustainability assessment and accreditation for institutions is also being discussed, reflecting the importance of sustaining engagement over time. 

Update from France: National Society Engagement 

The Société Française d’Anesthésie et de Réanimation (SFAR) continues to demonstrate leadership in sustainability, building on its long-standing commitment to patient safety, education, and research. 

In recent months, SFAR has supported initiatives to raise awareness of the environmental impact of anaesthesia practice. A particular emphasis has been placed on the reflection around eco-designed surgical care pathways. Utilising a care pathways approach allows us to appraise the entire patient journey and to identify areas where meaningful carbon savings can be made.  

Educational activities, including conference sessions and written communications, have highlighted practical steps that anaesthesiologists can take to reduce waste and emissions without compromising patient care. Sustainability is increasingly framed as an integral component of high-quality, modern anaesthesia practice rather than a separate agenda. 

SFAR’s engagement also reflects a broader national conversation in France about healthcare decarbonisation and environmental responsibility, positioning anaesthesia as an active contributor to system-wide change. 

Other Programmes of Interest 

Alongside the ICU and the N₂O project, a range of other sustainability programmes are gaining momentum. These include initiatives to reduce single-use plastics in anaesthesia, improve waste segregation in operating theatres, and engage with suppliers to encourage more sustainable product design and packaging. 

Energy efficiency is another growing area of interest. Operating theatres are among the most energy-intensive spaces in hospitals, and small changes, such as optimising ventilation settings when theatres are not in use, can deliver substantial environmental benefits. 

While no single intervention provides a complete solution, the cumulative impact of multiple, coordinated changes can be significant. 

Looking Ahead: Sustaining the Momentum 

Sustainability in anaesthesia is evolving rapidly from aspiration to action. The work of the Sustainability Committee, supported by committed Sustainability Ambassadors and engaged national societies, demonstrates what can be achieved through collaboration, evidence-based practice, and shared purpose. 

The next phase will focus on scaling successful initiatives, strengthening networks, developing research agendas, and embedding sustainability into routine clinical, educational, and organisational processes. By continuing to learn from one another and sharing experiences across borders, the anaesthesia community can play a leading role in building a more sustainable healthcare system. 

As these initiatives show, sustainability is not about doing more, it is about doing things differently, and doing them better, for patients today and for the generations that follow. 

Author: Jane Muret, NASC representative for France. Institut Curie, PSL Research University, Anaesthesia and Critical Care Medicine Department.

References

1. Gonzalez-Pizarro et al, European Journal of Anaesthesiology41(4):p 260-277, April 2024.|DOI:10.1097/EJA.0000000000001942
2. Buhre et al, European Journal of Anaesthesiology40(7):p 461-464, July 2023.|DOI:10.1097/EJA.0000000000001862
3. https://esaic.org/
4. Gonzalez-Pizarro et al, Eur J Anaesthesiol Intensive Care Med 2023; 2:4(e0025)