New research examining the climatic impact of gas emissions from operating theatres reinforces that anaesthetic gases such as desflurane significantly contribute to the carbon footprint of healthcare systems and highlights considerations for reducing this.
Researchers conducted a bottom-up purchase analysis of inhalation anaesthetics used in Dutch hospitals and surveyed anaesthesiologists online about their preferences for anaesthetic agents. The study aimed to quantify the climatic impact of inhaled anaesthetics in the Netherlands, examine the preferred anaesthesia techniques of Dutch anaesthesiologists and explore possible opportunities for reducing emissions.
Over 88% of hospital organisations in the Netherlands (n=61/69) provided purchase data for volatile anaesthetic agents. Inhaled anaesthetics contributed 12.2 kilotons of CO₂ equivalent emissions in 2019, making up 0.07% of the total emissions from the Dutch healthcare system. This is comparable to the annual emissions of approximately 6,700 cars.
The most commonly used inhaled anaesthetic was sevoflurane, which accounted for 93.4% of the total volume (9,178 litres). Other inhaled anaesthetics included desflurane and isoflurane, accounting for 4.1% (404 litres) and 2.5% (245 litres) respectively.
The survey also revealed that clinicians preferred intravenous anaesthetics over inhaled gasses. Propofol was the first choice of anaesthetic for 70% of the 182 respondents. The inhalation anaesthetic desflurane was only available in 16% of hospitals and 83% of anaesthesiologists reported never using it.
Nitrous oxide was also not commonly used, with 63% of respondents reporting they never used it and 27% of participants reporting usage in less than 5% of their cases.
The low use of high-emission anaesthetics such as desflurane and nitrous oxide, combined with the strong preference for intravenous propofol, contributes to the relatively low greenhouse gas emissions from inhaled anaesthetics in the Netherlands compared to other countries.
In the UK, for example, anaesthetic and analgesic gases were responsible for around 2% of all NHS emissions in 2023. The NHS committed to lowering this by 40% through the transformation of anaesthetic practices such as the nationwide decommissioning of desflurane, which came into force in April 2024.
Anaesthetic gases can have a significant environmental impact, with desflurane having a global warming potential (GWP) 2,500 times greater than carbon dioxide, while sevoflurane has 130 times GWP of carbon dioxide.
This study supports the continued reduction of high-emission inhaled anaesthetics and the promotion of intravenous alternatives as a way to transition to more sustainable anaesthetic practices.
The researchers also suggest that implementing guidelines, improving education on the environmental impact of anaesthesia choices, and optimising gas capture and recycling systems could further reduce the carbon footprint of anaesthetic procedures.
Reference
Friedericy, H. J. et al. Greenhouse gas emissions due to inhalation anaesthetics in the Netherlands, usage data and a survey of preferences among Dutch anaesthesiologists. European Journal of Anaesthesiology and Intensive Care. 2025, Feb.:DOI: 10.1097/EA9.0000000000000065.
