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Let's Implement the Sustainability Moment

Peter Menikefs, MDCM, FRCPC. Anita Rao, MDCM, FRCPC.

To the Editor,

We commend the Canadian Anesthesiologists’ Society for introducing environmental sustainability to this year’s Guidelines to the Practice of Anesthesia. As citizens of the planet, we must be mindful of the current climate crisis. As medical practitioners, to provide thoroughly holistic care, we are obliged to consider the environmental impact of the choices we make in our provision of care. To do so would be in keeping with the World Health Organization’s declaration that climate change is the single biggest threat facing humanity. Perioperative services contribute significantly to the health care sector’s environmental footprint. In recent years, our centers have taken many steps to green surgical and anesthesia practice. Some of these initiatives include the abolition of the use of desflurane, the reclamation and reprocessing of energy devices, and the recycling of polyvinyl chlorides (PVCs).

In our operating rooms, the introduction of new green initiatives is accelerating. Further, as teaching centers, we see significant turnover in our team membership given the

rotation of trainees. To provide focus to team members regarding these initiatives, we have recently introduced The Sustainability Moment.

Immediately following completion of the first phase of the Surgical Safety Checklist, a brief overview of green initiatives is provided to all team members by the anesthesiologist,

generally taking no more than fifteen seconds to complete. With the recent introduction of The Sustainability Moment to our operating rooms, feedback for its use has

been very positive. Observations would suggest that more complete separation of waste products (recyclables, biohazard waste, PVCs) occurs following the reminder

provided by The Sustainability Moment. Further, surgeons have verbalized that they are more mindful of equipment choices, such as selecting reusable over disposable

equipment, once they have been primed by The Sustainability Moment. And with trainees omnipresent in our operating rooms, it is hoped that they will take their

learnings and disseminate them to other facilities and individuals throughout their careers.

At a cost of no more than fifteen seconds per case, we recommend that operating rooms adopt the use of The Sustainability Moment.

Can J Anesth/J Can Anesth

Received: 26 January 2023 / Revised: 26 January 2023 / Accepted: 27 January 2023

Canadian Anesthesiologists’ Society 2023

P. Menikefs, MDCM, FRCPC (&)

Environmental Sustainability Working Group, Ontario’s

Anesthesiologists, Ontario, Canada


Department of Anesthesia, Unity Health, St. Joseph’s Health

Centre, University of Toronto, Toronto, ON, Canada


Department of Anesthesia, Trillium Health Partners, University

of Toronto, Mississauga, ON, Canada

Disclosures: None.

Funding statement: None.

Editorial responsibility This submission was handled by Dr.

Stephan K. W. Schwarz, Editor-in-Chief, Canadian Journal of

Anesthesia/Journal canadien d’anesthe ́sie.


1. Dobson G, Chau A, Denomme J, et al. Guidelines to the Practice of

Anesthesia: Revised Edition 2023. Can J Anesth 2023; https://doi.


2. World Health Organization. Climate change and health, 2021.

Available from URL:

detail/climate-change-and-health (accessed January 2023).

3. Kagoma Y, Stall N, Rubinstein E, Naudie D. People, planet and

profits: the case for greening operating rooms. CMAJ 2012; 184:


4. Hanna M, Bryson GL. A long way to go: minimizing the carbon

footprint from anesthetic gases. Can J Anesth 2019; 66: 838–9.

5. University of Calgary. Sample sustainability movements.

Available from URL:


offices.pdf (accessed January 2023).

Publisher’s Note Springer Nature remains neutral with regard to

jurisdictional claims in published maps and institutional affiliations.

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