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Copyright (c) 2025 Syarifah Noor Nazihah Sayed Masri, Samuel Ern Hung Tsan, Mohd Fitry Zainal Abidin Zainal Abidin, Huwaida Abdul Halim, Jennifer An Chi Ong, Shahridan Mohd Fathil, Mohd Zulfakar Mazlan, Sobha KK Gopala Kurup, Kwan Tuck Lee, Ina Ismiarti Shariffuddin
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Abstract
The healthcare sector contributes approximately 4%–5% of global greenhouse gas emissions, with anaesthetic practice identified as a notable source. Recognising the urgent need for environmentally sustainable approaches, the Malaysian Society of Anaesthesiologists (MSA) and College of Anaesthesiologists (CoA) have developed a national consensus statement to guide green and sustainable anaesthesia practice in Malaysia.
This consensus statement was formulated through a literature review, aligned with the principles of the World Federation of Societies of Anaesthesiologists (WFSA), and expert deliberation within the CoA-MSA Green Anaesthesia Working Group. It proposes practical strategies across the 3 carbon emission scopes: direct emissions (Scope 1), indirect energy-related emissions (Scope 2), and indirect supply chain-related emissions (Scope 3), while integrating workforce well-being as a core dimension of sustainability.
The statement recommends low-flow anaesthesia, restricted use of nitrous oxide, and preference for volatile agents with lower GWP. It promotes total intravenous and regional anaesthesia where clinically appropriate and encourages monitoring of anaesthetic depth to reduce unnecessary consumption of volatile agents. Scope 2 interventions include optimising energy use in operating theatres, deactivating systems outside operational hours, and transitioning towards renewable energy. Scope 3 focuses on reducing single-use items, implementing recycling, conducting life-cycle assessments, and strengthening sustainable procurement. Importantly, the consensus statement acknowledges the physiological and psychological challenges climate change imposes on anaesthesia providers, advocating institutional measures that safeguard staff health, hydration, and mental resilience.
This CoA-MSA statement represents Malaysia’s first national initiative to integrate sustainability into anaesthetic practice. By balancing environmental responsibility with patient safety and provider well-being, it calls on every anaesthesiologist to make the operating theatre a place that heals both patients and the planet. The document provides a roadmap for climate-resilient, resource-efficient, and compassionate anaesthetic care in Malaysia.
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