Sustainability in anaesthesia: are South African anaesthesia providers doing their part?

Background: The world's reliance on fossil fuels has led to broad environmental ramifications. The most significant is climate change, the acute rise in global temperatures due to greenhouse gas (GHG) emissions. Anaesthetists may be able to reduce the environmental footprint of a hospital and the healthcare system. This study attempted to ascertain the practices of South African anaesthesia providers and compare these practices to international sustainability recommendations. Methods: Through an analytical, cross-sectional study, members of the South African Society of Anaesthesiologists (SASA) were surveyed. After a literature review, a survey was constructed based on current recommendations and reviewed for face validity. The data was exported to a spreadsheet for statistical analysis. Associations were described using the chi-square or Fisher's exact test for categorical data and the t-test or Kruskal-Wallis test for numerical data. Results: Volatile anaesthesia without nitrous oxide (N2O) was reported as the preferred (73.5% first choice) anaesthetic technique. Total intravenous anaesthesia (TIVA) and regional/neuraxial-only anaesthesia were equally selected as the practitioner's second preference. The use of N2O with volatiles is very unpopular. Sevoflurane was the most preferred volatile agent (79.9% first choice). Isoflurane and desflurane were popular second-choice agents. Anaesthetists comply with some recommendations and neglect others. The use of low fresh gas flows (FGF), reusable laryngoscope blades, TIVA, and regional/neuraxial-only techniques are in keeping with the recommendations. Single-use laryngeal mask airways (LMA), desflurane, and frequent replacement of breathing circuits breach the recommendations. Anaesthetists are willing to incorporate sustainability into their practices but identified lacking education, staff attitudes, and poor leadership as barriers to improvement. Conclusion: South African anaesthesiologists perform well in certain aspects of sustainability, but not all of them. This is comparable to international literature. The significant differences in practice among subgroups of anaesthetists are unique to the South African context. Overall, the study showed opportunities for improvement throughout the South African anaesthesia fraternity.