Applying the 7 WFSA Sustainability Principles with Local-regional Anaesthesia

Anaesthesia providers are increasingly focused on the environmental impact of their clinical practice. It is understood that their specialty contributes to the healthcare sector’s carbon footprint, yet there is often a lack of clear guidelines on how to implement more sustainable practices effectively. This article serves as a technical guide to address this, using the official framework from the World Federation of Societies of Anaesthesiologists (WFSA) to structure the approach.

This article covers:

• A presentation of the 7 official WFSA Consensus Principles for Environmentally Sustainable Anaesthesia, providing a global framework for action.
• An analysis of how local-regional anaesthesia (LRA) serves as a practical application of these principles, from minimizing direct environmental impact to aligning with broader strategies like research and industry collaboration.

A Framework for Action: The 7 WFSA Sustainability Principles

To move from awareness to action, a clear framework is needed. The 2023 “Consensus principles of environmentally sustainable anaesthesia” from the WFSA provides this essential guidance. These principles offer a clear roadmap for anaesthesia providers to reduce the environmental impact of their work.

Anaesthesia providers should:

1. Minimize the environmental impact of their clinical practice.
2. Use environmentally preferable medications and equipment when clinically safe to do so.
3. Minimize the overuse/waste of medications, equipment, energy and water.
4. Incorporate environmental sustainability principles within formal anaesthesia education.
5. Embed environmental sustainability principles within anaesthesia research and quality improvement programs.
6. Lead environmental sustainability activity within their healthcare organizations.
7. Collaborate with industry to improve environmental sustainability.

These points provide a comprehensive structure for clinicians to assess and improve their practices.

How LRA Aligns with the 7 WFSA Sustainability Principles

Local-regional anaesthesia is a practical tool that allows clinicians to apply these principles directly in their daily work. The characteristics of LRA align well with the WFSA’s recommendations.

Minimizing Impact and Waste: Principles 1 & 3

These two principles are addressed effectively with LRA. The technique avoids volatile agents like desflurane, which are a primary source of the specialty’s CO₂ emissions. This directly supports the goal of minimizing environmental impact. In addition, LRA is aprecise technique that requires smaller, targeted doses of medication, which aligns with the call to minimize the overuse and waste of medications.

Using Environmentally Preferable Options: Principle 2:

This principle involves making conscious choices about clinical tools. LRA is considered an environmentally preferable technique because it allows for the use of targeted medications and minimal material. The use of ultrasound guidance further supports this, as it enables clinicians to administer smaller, more precise doses while maintaining clinical efficacy, which reduces overall pharmaceutical consumption.

Embedding Sustainability in Research and Quality Improvement: Principle 5:

Anaesthesia providers are called to integrate sustainability into their research and quality improvement protocols. LRA is well-established in this area, having been studied as an eco-friendly technique. It is already successfully integrated into quality improvement protocols such as Enhanced Recovery After Surgery (ERAS). (White & Shelton, 2019)

Leadership and Industry Collaboration: Principles 6 & 7:

When clinicians choose LRA, they demonstrate leadership in sustainability within their organizations (Principle 6). This extends to collaboration with the industry (Principle 7). A clear example is the development of procedure-specific sets, or custom packs. These sets are a result of collaboration between clinicians and suppliers to rationalize materials and reduce waste, showing how they can work together to improve environmental sustainability.

A Practical Path to Sustainable Anaesthesia

The WFSA principles provide the specialty with clear, actionable goals for sustainability. Local-regional anaesthesia has been shown to offer clinicians a practical and effective approach to applying these principles. The use of LRA allows for the direct reduction of environmental impact, optimization of resource use, and leadership in sustainability efforts in the field. This alignment makes LRA a key component of a modern, responsible anaesthesia practice.

Bibliography

1. White, S. M., Shelton, C. L., Gelb, A. W., Lawson, C., McGain, F., Muret, J., & Sherman, J. D. (2022). Principles of environmentally sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia, 77(2), 201-212.