Environmentally sustainable anaesthesia: a cross-sectional survey of anesthesiologists in teaching hospitals of Karachi, Pakistan

Background: Anaesthesia is a recognized contributor to healthcare-related greenhouse gas emissions and operating room waste. While high-income countries (HICs) have begun implementing sustainability initiatives, evidence from lower-middle-income countries (LMICs) is limited. This study aimed to assess the knowledge, attitudes, and practices of anesthesiologists in teaching hospitals in Karachi, Pakistan, regarding environmentally sustainable anaesthesia, using the World Federation of Societies of Anesthesiologists (WFSA) consensus principles as a benchmark. Methods: We conducted a cross-sectional survey of consultant anaesthesiologists, trainees, and staff anaesthesia medical officers in College of Physicians and Surgeons Pakistan-accredited teaching hospitals in Karachi. Items were grouped a priori into Knowledge (4 items), Attitude (8 items), and Practice (9 items) domains. Composite scores were calculated (1–7 scale), and internal consistency was assessed with Cronbach’s alpha. Between-group differences were evaluated using Mann–Whitney U or Kruskal–Wallis tests. An ordinal logistic regression was used to identify predictors of Practice category, and a linear regression sensitivity analysis was performed using continuous Practice scores. Results: Eighty-two respondents participated (51% public, 49% private institutions). Internal consistency was acceptable for all domains (α = 0.73–0.8). Mean (SD) scores were: Knowledge 6.10 (0.77), Attitude 5.99 (0.73), and Practice 5.24 (0.87). Over 90% agreed with actions such as measuring departmental carbon footprints and favoring well-maintained circle systems. No significant differences in scores were observed by institution type or designation categories. In regression analysis, Attitude was a significant predictor of Practice. The modest sample size may limit statistical power and the stability of regression estimates. Conclusion: Anaesthesiologists in teaching hospitals in Karachi demonstrated high knowledge and positive attitudes toward sustainable anaesthesia, but reported practice was lower and may be overestimated by self-report. Given the modest sample size and single-city design, caution is warranted in generalizing these findings beyond similar urban academic settings. Trial registration: Not applicable.