Ep125. The Anaesthesia Iceberg

In this episode, I talk about the environmental impact of oral versus intravenous paracetamol. It accompanies a really 'cool' poster in the September 2026 edition of Australian Anaesthetist.Download the September 26 Australian Anaesthetist here.Similar podcast episodes:Ep69. Talking TRA2SH with Dr Jess DaviesEp119. Sharps Waste AuditEp114. Measuring Nitrous Oxide LeaksSome AI generated notes:Key TakeawaysOral paracetamol is clinically equivalent to IV formulation for postoperative analgesia, making the switch a low-risk, evidence-based practice changeEnvironmental impact is substantial: switching from IV to oral could reduce carbon emissions by 45-68 times per dose when accounting for full lifecycle and disposalImplementation barriers are behavioral rather than clinical. Awareness, institutional protocols, and prescriber engagement are critical success factorsPractical strategies include data-driven audits of current IV usage, standardized prescribing pathways through pre-admission clinics or day-of-admission nursing protocols, and standing orders in private facilitiesScale matters: 50 million eligible patients across three countries means individual practice changes compound into globally significant environmental and economic impactQuotable Moments"When you take into account disposal of the ampoules and all the associated packaging, and remember those glass bottles often require high temperature incineration, then IV paracetamol generates 45 to 68 times the amount of emissions compared to oral paracetamol.""We know oral paracetamol is cheaper. We know it's better for the environment. And we know it's just as effective as IV paracetamol. But we're not prescribing it for our patients.""Knowing your data is such a powerful motivator."