Environmentally sustainable anaesthesia in Africa: A scoping review of current knowledge, practices and challenges

Abstract

Background: Climate change is one of the greatest threats to global health, and anaesthesia contributes via inhalational anaesthetic gases (IAGs), intravenous agents, disposable equipment, and reprocessing of reusable equipment. Africa faces unique healthcare challenges, yet the extent to which environmentally sustainable anaesthesia has been studied on the continent remains unclear. Understanding existing knowledge and practices is crucial to developing context-specific strategies.
Aim: This scoping review aimed to map existing literature on environmentally sustainable anaesthesia in Africa, identifying current knowledge, practices, and implementation challenges.
Setting: The study was conducted on research findings in Africa.
Methods: A scoping review was conducted using the Arksey and O’Malley framework and PRISMA-Scoping Review guidelines. Databases searched included PubMed, EBSCOhost, Scopus, Web of Science, and the Environmental Science Collection. Eligible studies were peer-reviewed, English-language articles published between 2000 and 2025, focusing on environmentally sustainable anaesthesia in Africa. Data were charted using an extraction form and underwent thematic analysis.
Results: Sixteen studies met the inclusion criteria. Most were cross-sectional and descriptive, with research largely conducted in South Africa. Key barriers included limited education and training, financial constraints, and the absence of formal institutional policies on environmental sustainability. Resource limitations influenced practice patterns, with increased reliance on total intravenous anaesthesia and regional techniques, both with relatively lower environmental footprints. Waste management practices were inconsistently implemented and often poorly understood. Anaesthetists generally showed limited awareness of the environmental impact of IAGs, and the reuse of equipment – frequently driven by necessity – raised ongoing concerns about infection control.
Conclusion: Research on environmentally sustainable anaesthesia in Africa is largely confined to South Africa, with scarce data from the rest of the continent. Clinical practice is heavily shaped by resource scarcity.
Contribution: This is the first synthesis of environmentally sustainable anaesthesia practices in Africa, highlighting resource-driven environmentally sustainable techniques, gaps in knowledge and policy.