釐清永續麻醉討論之關鍵爭議

Reframing Key Debates in Sustainable Anesthesia

隨著永續醫療逐漸制度化，麻醉實務亦被納入環境衝擊的檢視範疇。近年台灣麻醉界圍繞全球暖化潛勢（global warming potential，GWP）與異丙酚（propofol）污染的討論，反映對環境議題的重視，亦顯示部分科學概念在實務論述中被去脈絡化，成為延宕行動的理由。本文聚焦兩項常見爭議：其一為GWP具方法學限制，是否意味麻醉氣體的氣候影響可忽略；其二為propofol具水生毒性，是否足以否定全靜脈麻醉。透過整理關鍵科學文獻與國際評估框架，本文指出，GWP的不確定性不足以推翻麻醉氣體間相對氣候衝擊差異達量級的臨床判斷；而propofol的環境風險，亦應置於實際暴露與治理情境中評估，其潛在影響主要集中於可治理的醫院源頭排放。本文並提出永續麻醉之實務框架，以協助麻醉醫師在不確定性中做出可行的臨床判斷。

As sustainable healthcare becomes increasingly institutionalized, anesthetic practice is being examined for its environmental impact. In Taiwan, recent debates on global warming potential (GWP) and propofol pollution reflect growing environmental awareness, but also show how scientific concepts can be taken out of context and used to delay clinical action. This article addresses two common controversies: whether the methodological limitations of GWP mean that the climate impact of anesthetic gases can be ignored, and whether the aquatic toxicity of propofol is sufficient to rule out total intravenous anesthesia. Based on key scientific literature and international assessment frameworks, it is shown that uncertainty in GWP does not negate the large differences in climate impact among anesthetic gases. Likewise, the environmental risk of propofol should be assessed in real-world exposure and management settings, as its potential impact is mainly concentrated at manageable hospital point sources. A practical framework for sustainable anesthesia is also proposed to support anesthesiologists in making feasible clinical decisions under uncertainty.