TOPLINE

Disposable products accounted for 80% of the carbon footprint associated with anesthesia during cesarean delivery, with prepackaged neuraxial trays and syringes being the largest contributors.

METHODOLOGY

• Researchers conducted a prospective observational study at a tertiary hospital in Netherlands to assess the carbon footprint of anesthesia during 50 cesarean deliveries performed between July and October 2025.
• Spinal anesthesia was used for 94% of deliveries, and combined spinal-epidural anesthesia was used for 6%; no general anesthesia was administered.
• The carbon footprint of anesthesia drugs and disposable products was calculated using life-cycle assessment data and expressed in kilograms of carbon dioxide equivalents (kg CO₂-eq). For pharmaceuticals, the calculation used data on immediate packaging and the production of active pharmaceutical ingredients.
• Data were recorded for disposable products specific to neuraxial anesthesia procedures, including products in prepackaged anesthesia trays. Details of pharmaceuticals were also recorded, along with the number of anesthesia team members, procedure times, and urgency levels.
• Researchers in the operating room documented all disposable products and pharmaceuticals used or administered during each procedure. Products that were opened but unused were also documented to assess their contributions to waste and the carbon footprint.

TAKEAWAY

• The mean carbon footprint of anesthesia pharmaceuticals and disposable products was 5.6 kg CO₂-eq per cesarean delivery; disposables contributed 80% of the total, while pharmaceuticals contributed 20%.
• Prepackaged neuraxial trays had the largest carbon footprint at 1.1 kg CO₂-eq (20% of the total), followed by syringes, which contributed 14%.
• Unused disposable products contributed 0.24 kg CO₂-eq (accounting for 4.4% of the total footprint), with a mean of 7.4 items wasted per surgery, predominantly from prepackaged trays.
• Among pharmaceuticals, intravenous cefazolin had the highest carbon footprint, followed by Plasma-Lyte 148 and 0.9% sodium chloride solutions; pharmaceutical packaging (0.98 kg CO₂-eq) had a much larger impact than active pharmaceutical ingredients (0.12 kg CO₂-eq).

IN PRACTICE

"Optimising disposable use is important to reduce emissions, with a focus on whether each item is necessary for a specific surgery before it is opened," the researchers wrote. "[E]nvironmental impact results are inherently context dependent, particularly with respect to the underlying electricity grid mix and upstream energy systems. Therefore, our findings are most applicable to the European setting, and we recommend that international readers interpret these results in light of the grid carbon intensity and relevant energy source market shares in manufacturing processes within their own contexts."

SOURCE

The study was led by Lisanne H.J.A. Kouwenberg, at Amsterdam UMC, University of Amsterdam in Amsterdam, Netherlands. It was published online on August 28 in the British Journal of Anaesthesia.

LIMITATIONS

The presence of a researcher in the operating room may have altered staff behavior. Incomplete data on material composition for some disposables and pharmaceuticals could affect the estimation of the true impact. The carbon footprint of five different active pharmaceutical ingredients, including oxytocin, could not be obtained.

DISCLOSURES

The study was supported by the Transforming Health and Care Systems program of the EU Horizon Europe Research and Innovation Programme and the Amsterdam Public Health Research Institute. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.