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Reducing the Carbon Footprint of General Anaesthesia: A Comparison of Total Intravenous Anaesthesia vs. Mixed Anaesthetic Strategy in 47,157 Adult Patients
17 Pages Posted: 1 Nov 2023
More...Abstract
Background: Global warming is a public health concern. Volatile anaesthetics significantly increase healthcare's carbon footprint. Laboratory studies suggest that total intravenous anaesthesia (TIVA) is less carbon intensive than volatile anaesthesia to perform general anaesthesia in adults, with equal quality of care. We aimed to compare the carbon footprint per general anaesthesia of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy, and to extrapolate these results at a global level.
Methods: This comparative retrospective study was conducted over two years in two French hospitals, one using TIVA only and one using a mixed strategy including both TIVA and inhaled anaesthesia techniques. Based on pharmacy procurement records, quantity of anaesthetic sedative drugs was converted to CO2-equivalent (CO2e). Primary outcome was the difference in carbon footprint per intervention between the two strategies and its projection at a global scale.
Findings: From January 1, 2021, to December 31, 2022, 24,962 patients were operated under general anaesthesia in the TIVA strategy and 22,017 in the mixed strategy. Carbon footprint of sedation per intervention in TIVA strategy was 20 times lower than the mixed strategy, with emissions of 2.32 kg and 47.97 kg CO2e per intervention, respectively. Global extrapolation yielded 468 kilotons and 9,596 kilotons of CO2e annually for TIVA and mixed strategies, respectively.
Interpretation: TIVA strategy significantly reduces carbon footprint of sedation in general anaesthesia in adult patients compared to a mixed strategy. Transitioning globally to TIVA could considerably decrease carbon footprint of general anaesthesia but could increase plastic and water pollution. Further research is warranted to assess the risk-benefit ratio of widespread TIVA adoption.
Funding: None
Declaration of Interest: We declare no competing interests.
Ethical Approval: According to the French law, our study has been classified as research not involving human subjects, and was approved by our local ethic committee (GDPR 2019-01 PADS23-195).
Keywords: anaesthesia, climate change, global warming, carbon footprint, environment, sustainability, TIVA, halogenated
Suggested Citation: Suggested Citation
