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Withdrawing volatile anaesthetic agents limits options for patients, particularly women and children

Mark W Davies consultant anaesthetist Sherman and Chesebro provide strategies for reducing inhaled anaesthetic pollution in their editorial.1 Although arguably the greatest conjuring trick of all time, for many, anaesthesia represents little more than the flick of a switch for consciousness. Little to understand other than where that switch is. Easy to take for granted that the various anaesthetic switches would be interchangeable. Easy to propose the universal adoption of a single “best switch.” Easy to regard the use of other “less good” switches, particularly those with more environmental impact, as being undesirable, uninformed, and unnecessary. This, however, is to completely misunderstand the way that anaesthetists constantly exploit the pharmacological and physical characteristics of the different anaesthetics, and attempt to best match them to the needs of individual patients. Many anaesthetists, in recognition of their significantly larger environmental footprints, have already stopped using desflurane and nitrous oxide, but this cessation has come at a cost, albeit modest, to some patients, and has effectively been without their sanction, knowledge, or bidding. Withdrawal of all volatile anaesthetic agents, and a move to the exclusive use of the intravenous agent propofol, would seriously limit the options available to patients, particularly women and children. If further restrictions are to be made, they should be only with the fully informed consent of society, rather than being made on its behalf, in what is supposed and hoped to be its best interests. There is little more important than saving the planet for mothers and children of tomorrow—other than providing high quality care for the children and mothers of today.