Carbon Footprint of Anesthesia: Comment

We read with great interest the recent article by McGain et al. entitled “Carbon Footprint of General, Regional, and Combined Anesthesia for Total Knee Replacements.”1 We congratulate the authors for their meticulous analysis of the factors that contribute to carbon emissions including less commonly included factors such as variable electricity sources, and for sharing their established sustainable practices with the Anesthesiology community.However, carbon emissions are only one consideration when evaluating environmentally sustainable practice. The authors’ life cycle analysis does not include the carbon-free (but still harmful) impact of single-use plastics. As plastic does not readily degrade, it releases a negligible amount of carbon after reaching the landfill, thereby limiting its life cycle carbon contribution to its production process. Yet significant environmental harm occurs at plastic’s life cycle endpoint through landfill use, breakdown into microplastics,2 and the release of volatile organic compounds,3 all of which are not accounted for in carbon equivalents. Solely focusing on carbon emissions can lead to false conclusions being drawn about the sustainability of disposable plastics (1.1 to 3.3 kg CO2/kg, from the authors’ article) and resterilized reusable equipment (3.0 kg CO2/kg), with medical industries marketing single-use equipment as “carbon friendly.”4We posit that the total environmental impact of resterilizing and reusing equipment is eclipsed by the short- and long-term harm of single-use disposables. We applaud the authors’ commitment to reusable equipment, from anesthesia circuits to spinal kit trays, and encourage the reporting of any available safety data associated with this practice to assist others in reducing their reliance on single-use plastic.The authors declare no competing interests.