The green anaesthesia dilemma: to which extent is it important to preserve as many drugs available as possible

Purpose of review This article aims to summarize the current literature describing the availability of different anaesthetic drugs, and to discuss the advantages and limitations of a self-imposed restriction on the scarcely existing anaesthetic drugs. Recent findings Earth temperature has risen 1.2°C since the beginning of industrial age, and it is expected to exceed a 1.5°C increase by 2050. The Intergovernmental Panel on Climate Change depicts five different scenarios depending on how these increased temperatures will be controlled in the future. The European Commission has formulated a proposal to regulate fluorinated greenhouse gases (F-gases), among which desflurane, isoflurane and sevoflurane belong to, due to their high global warming potential. This proposal shall ban, or severely restrict, the use of desflurane starting January 2026. It is not clear what might happen with other F-gas anaesthetics in the future. Due to climate change, a higher number of health crisis are expected to happen, which might impair the exiting supply chains, as it has happened in previous years with propofol scarcity. Summary There are just a handful number of available anaesthetics that provide for a safe hypnosis. Major stakeholders should be consulted prior making such severe decisions that affect patient safety.