ESAIC's declaration for sustainability within anaesthesiology and intensive care.

Tackling climate change has never been more of a pressing matter. The climate clock, which counts down the critical window for effective climate action, is running fast. Measures leading to thorough change in our daily lives must be taken now, before it is too late. That requires a substantial cultural shift. To reduce our environmental impact and frame a more climate-friendly future, all of us must integrate a commitment to environmental sustainability, across all spheres of human activity. Environmental sustainability is a crucial issue that affects all of us, including the field of anaesthesiology, peri-operative medicine, pain medicine and intensive care. As healthcare professionals, we are responsible for reducing our negative environmental impact and promoting sustainable practices that benefit both our planet and our patients, by maintaining and enhancing quality of care and patient safety. This goal requires co-operation from all stakeholders. To address environmental issues, the European Society of Anaesthesiology and Intensive Care (ESAIC) has developed the Glasgow Declaration, a roadmap to environmental sustainability within the fields of anaesthesiology, peri-operative medicine and intensive care.1 The healthcare industry is responsible for roughly 5% of global greenhouse gas emissions. Peri-operative care contributes a significant part of it, because of anaesthetic agents emitted into the atmosphere, intense energy consumption in the operating room, complex supply chains and waste management. For this reason, the field of anaesthesiology, peri-operative medicine and intensive care has a significant role to play in reducing healthcare systems’ carbon footprint and ensuring environmental sustainability. The Glasgow Declaration focuses on three key areas: medication use, energy use and recirculation in processes and waste. We can achieve significant gains in environmental sustainability by taking action in these areas. Recommendations include favouring anaesthetics and procedures with the lowest global warming potential; using halogenated agents at the lowest possible fresh gas flow, coupled, whenever possible, with scavenging devices that allow for re-use and recirculation of anaesthetic drugs; and stockpiling emergency-use medications with careful monitoring. Energy use in hospitals, particularly from heating, ventilation and air conditioning systems (HVAC), represents a significant portion of overall energy consumption in the operating room and ICUs. Recommendations to reduce energy use include optimising HVAC settings, incorporating renewable energy sources, utilising energy efficient lighting and employing water conservation. To favour recycling in processes and waste, the Glasgow Declaration recommends considering the purchase of reusable or reprocessed equipment, avoiding single-use items without clear patient care benefits, reducing waste generation, educating staff on waste management, and implementing measures to reduce pharmaceutical pollution of waste water. We all should focus on reducing, re-using and recycling whenever possible. The Glasgow Declaration aims to encourage and guide European countries to incorporate sustainability into their healthcare plans, emphasising the need for multidisciplinary dialogue, adaptation to local contexts, comprehensive training and communication with relevant stakeholders. Only by working together can we achieve our vision of enhanced sustainability in anaesthesiology, peri-operative medicine and intensive care, for the benefit of our patients, our society and our planet.