Sustainable anesthesia practice – a survey of knowledge, attitudes and practices among CRNAs and SRNAs in South Florida, USA

Abstract

Background: Healthcare has a substantial environmental impact through high greenhouse gas (GHG) emissions. Anesthesia care is associated with significant environmental impact due to inhalational anesthetic gases, solid waste generation and resource- and energy-intensive perioperative practices. In the United States, Certified Registered Nurse Anesthetists (CRNAs) and Student Registered Nurse Anesthetists (SRNAs) play an important role in implementing sustainable anesthesia practices. However, limited empirical knowledge exists regarding CRNAs’ and SRNAs’ knowledge, attitudes and clinical practices related to sustainable anesthesia care within the context of the United States healthcare system. Aim: The aim of this study was to describe and examine the knowledge, attitudes and clinical practices of CRNAs and SRNAs regarding sustainable anesthesia care in South Florida, USA. Method: This study used a primarily quantitative cross-sectional survey design with elements of mixed methods research. Data were collected through an anonymous web-based survey distributed to CRNAs and SRNAs in South Florida, USA. The survey included Likert-scale questions and open-ended questions exploring knowledge, attitudes and practices related to sustainable anesthesia care. Quantitative data were analyzed using descriptive statistics, while qualitative responses were analyzed using deductive content analysis. Results: A total of 33 participants completed the survey, including 7 CRNAs and 26 SRNAs. The SRNAs generally reported greater exposure to formal sustainability-related education and higher self-perceived knowledge compared with the CRNAs. Both groups demonstrated generally positive attitudes toward sustainable anesthesia care. In terms of practices, low-flow anesthesia techniques were commonly reported, while preference for total intravenous anesthesia (TIVA) for environmental reasons was limited. Organizational barriers such as production pressure, limited organizational support and insufficient communication of sustainability-related guidelines were identified as factors influencing the implementation of sustainable practices. Additionally, concerns regarding patient safety and infection prevention were also identified as factors influencing implementation. Conclusion: Both CRNAs and SRNAs demonstrated positive attitudes toward sustainable anesthesia care and expressed support for integrating environmental considerations into anesthetic decision-making. However, the implementation of sustainable practices appeared inconsistent, indicating an attitude–practice gap influenced by organizational and clinical barriers. Given the relatively small sample size, these findings should be considered exploratory and interpreted with caution. Increased education, stronger leadership support and clearer sustainability-related guidelines may therefore be important factors in strengthening the implementation of sustainable anesthesia practices within the United States healthcare context.