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WFSA Statement on the Environmental Sustainability Checklist

Posted: By: Jyoti Shrestha

WFSA calls for Member Societies to endorse the Anaesthesiology Environmental Sustainability Checklist, which draws together current evidence-informed actions that can mitigate health care pollution, and improve resilience and health equity.

Developed by the WFSA Sustainability Committee: Xiadong Chen (China), Seema Gandhi (USA), Simantika Ghosh (India), Vivian H Y Ip (Canada), Pui San Loh (Malaysia), Craig McClain (USA), Forbes McGain (Australia), Nathalie Mejeni (Cameroon), Salome Meyer (Switzerland), Gwen Morgan (South Africa), Jane Muret (France), Christian Nilo Schultz (Chile), Cliff Shelton/Deputy Chair (UK), Jodi Sherman/Chair (USA), with Charlotte Taylor (UK)

Anaesthesiology is a resource-intensive specialty that unintentionally contributes to healthcare pollution and climate change, harming environmental and population health [1]. Preventing pollution is a matter of patient safety [2]. Professional societies and colleges set practice norms, influence graduate and postgraduate core competency development, and affect policies that govern safe, high-quality anaesthesia care. Therefore, these professional bodies should integrate sustainability into core efforts to improve patient care and secure a healthy future.

The WFSA recommends member societies endorse the Anaesthesiology Environmental Sustainability Checklist, which draws together current evidence-informed actions that can mitigate health care pollution, and improve resilience and health equity.

Anaesthesia professionals have a high degree of autonomy, and sustainable decision-making at the point of care can have considerable impact on reducing pollution without affecting patient-centred outcomes. This means that anaesthesia professionals have both the responsibility and the capability to deliver care in a less polluting way. However, certain interventions must occur at the department level, across a healthcare system, or even at a country-wide policy level for most effective impact. As such, actions span micro, meso, and macro levels.

The WFSA Anaesthesiology Sustainability Checklist was developed through identification and careful review of sustainable practice guidance documents and statements from member societies. Sixteen professional resources were identified reflecting five of the six WHO geographic regions [3-18]. Nine documents were country-specific (two from Canada [3,4], and one each from Australia [5], Belgium [6], Columbia [7], France [8], Germany [9], United States [10] and the United Kingdom [11]). Seven documents stemmed from multinational anaesthesiology societies (two from European Society of Anaesthesiology and Intensive Care [12,13], one from the Common Interest Group* [14], two from the Association of Anaesthetists [15,16], one from Australia and New Zealand College of Anaesthetists [17], and one global from WFSA) [18]. These professional resources and references were reviewed, evidence-informed action points extracted and sorted by topic, and then compared for congruence to support the following WFSA Environmental Sustainability Checklist.

*Common Interest Group includes the Association of Anaesthetists, American Society of Anesthesiologists, Australian Society of Anaesthetists, Canadian Anaesthetists Society, New Zealand Society of Anaesthetists, and South African Society of Anaesthesiologists.

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References:

  1. McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth. 2020;125:680-692. doi: 10.1016/j.bja.2020.06.055.
  2. Sherman JD, Thiel C, MacNeill A, et al. The Green Print: Advancement of Environmental Sustainability in Healthcare. Resources, Conservation and Recycling. 2020;161:104882. doi: 10.1016/j.resconrec.2020.104882
  3. Dobson G, Chau A, Denomme J, et al. Guidelines to the Practice of Anesthesia—Revised Edition 2024. Can J Anesth. 2024; 71: 8-54. Doi: 10.1007/s12630-023-02675-0.
  4. Walker M, Sondekoppam R, Filteau L, Rao A, Williams S, Ip VHY; Canadian Anesthesiologists’ Society. Canadian Anesthesiologists’ Society position statement on greening the operating room. Can J Anaesth. 2025 Oct;72(10):1475-1488. English. doi: 10.1007/s12630-025-03053-8.
  5. Queensland Government. Checklist – Perioperative Environmental Sustainability Activities. 2024. https://www.health.qld.gov.au/ data/assets/pdf_file/0026/1432556/54a5df2f1 4ecb5b87e0501ebc8d44070aadaa256.pdf. Accessed 15/02/2026.
  6. Hendrickx J, Kalmar A, Bonhomme V, et al. BeSARPP (Belgian Society of Anesthesiology, Resuscitation, Perioperative medicine and Pain management) recommendations on responsible and sustainable use of inhaled anesthetics: NO time TO WASTE. Acta Anaesth Bel. 2023; 74: 247-250. Doi: 10.56126/74.4.24.
  7. Calvache JA. The environmental responsibility of modern anesthesiology and perioperative care. Colomb J Anesthesiol. 2024; 52. Doi: 10.5554/22562087.e1103.
  8. Pauchard JC, Hafiani EM, Bonnet L, et al. Guidelines for reducing the environmental impact of general anaesthesia. Anaesth Crit Care Pain Med. 2023; 42: 101291. Doi: 10.1016/j.accpm.2023.101291.
  9. Schuster M, Richter H, Pecher S, Koch S, Coburn M. Ecological Sustainability in Anaesthesiology and Intensive Care Medicine: A DGAI and BDA Position Paper with Specific Recommendations. Anästh Intensivmed. 2020; 61: 329–338. Doi: 10.19224/ai2020.329.
  10. American Society of Anesthesiologists. Anesthesiology Sustainability Checklist. 2024. https://www.asahq.org/about-asa/governance-and-committees/asa-committees/environmental-sustainability/greening-the-operating-room/checklists. Accessed 15/02/2026.
  11. Brighton & Sussex Medical School, Centre for Sustainable Healthcare, and UK Health Alliance on Climate Change. Green surgery: Reducing the environmental impact of surgical care (v1.1). 2023. https://ukhealthalliance.org/sustainable-healthcare/green-surgery-report/. Accessed 15/02/2026.
  12. Gonzalez-Pizarro P, Brazzi L, Koch S, et al. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol. 2024; 41: 260-277. Doi: 10.1097/EJA.0000000000001942.
  13. Bruhe W, De Robertis E, Gonzalez-Pizarro P. The Glasgow declaration on sustainability in Anaesthesiology and Intensive Care. Eur J Anaesthesiol. 2023; 40: 461-464. Doi: 10.1097/EJA.0000000000001862.
  14. Association of Anaesthetists, American Society of Anesthesiologists, Australian Society of Anaesthetists, Canadian Anesthesiologists Society, New Zealand Society of Anaesthetists, South African Society of Anaesthesiologists. Environment and Sustainability Statement from the Common Issues Group Partners. 2020. https://www.sasaweb.com/wp-content/uploads/2022/08/Environment-and-Sustainability-Statement-from-the-Common-Issues-Group.pdf. Accessed 15/02/2026.
  15. Association of Anaesthetists. The 5R Approach. Date not specified. https://anaesthetists.org/Home/Resources-publications/Environment/Guide-to-green-anaesthesia/The-5R-approach. Accessed 15/02/2026.
  16. The Royal College of Surgeons of Edinburgh, Royal College of Surgeons of England, Royal College of Surgeons in Ireland, Royal College of Physicians and Surgeons of Glasgow, Association of Anaesthetists, Association for Perioperative Practice, Royal College of Anaesthetists. Intercollegiate Green Theatre Checklist v2.0. 2025. https://rcoa.ac.uk/sites/default/files/documents/2025-02/green-theatre-checklist.pdf. Accessed 15/02/2026.
  17. Australian and New Zealand College of Anaesthesia. PS64(G) Position statement on environmental sustainability in anaesthesia and pain medicine practice 2019. 2019. https://www.anzca.edu.au/getContentAsset/e5aebe53-7d5f-4403-a614-999df0ab1062/80feb437-d24d-46b8-a858-4a2a28b9b970/PS64(G)-Environmental-sustainability-2019.pdf?language=en&view=1. Accessed 15/02/2026.
  18. White SM, Shelton CL, Gelb AW, et al. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia. 2022; 77: 201-212. doi: 10.1111/anae.15598
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