{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:40:38Z","timestamp":1792478438771,"version":"4.5.0"},"reference-count":34,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100008413","name":"Instrumentariumin Tiedes\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008413","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007417","name":"Paulon S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007417","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Spinal and general anaesthesia seem to lead to similar health\u2010related outcomes in total knee arthroplasty. However, to produce economically and environmentally sustainable health care, we should also consider other factors. Current guidelines recommend preferring regional anaesthesia and total intravenous anaesthesia to reduce environmental impact. In this study, we analysed time, costs, and disposable materials associated with spinal anaesthesia and total intravenous anaesthesia during total knee arthroplasty.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 395 patients undergoing total knee arthroplasty were randomised to spinal or general anaesthesia. Outcomes were total operating room time, non\u2010operative operating room time, post\u2010anaesthesia care unit time, use of drugs affecting haemodynamics, and the need for arterial cannulation and urinary catheterisation. In addition, we evaluated the financial costs and waste produced by single\u2010use equipment and medicines in both anaesthesia methods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Anaesthesia method did not affect operating room time (median 152\u2009min [interquartile range 136\u2013168\u2009min] vs. 150\u2009min [137\u2013165\u2009min], Hodges\u2013Lehmann estimate 2\u2009min [95% CI \u20133 to 6\u2009min],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.49). However, after spinal anaesthesia, patients appeared to spend more time in the postanaesthesia care unit than after general anaesthesia (median 104\u2009min [71\u2013148\u2009min] vs. 73\u2009min [49\u201398\u2009min], Hodges\u2013Lehmann estimate 32\u2009min [95% CI 23\u201342\u2009min],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Medication for hypotension was more common in the general anaesthesia group, whereas medication for hypertension was more common in the spinal anaesthesia group. General anaesthesia generated more disposable material (1252 vs. 611\u2009g), and both medicine and equipment expenses were higher (total costs \u20ac83 vs. \u20ac36).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>With this anaesthesia regimen, knee arthroplasty patients occupied the operating room for a similar duration regardless of anaesthesia method, but patients required longer recovery in the postanaesthesia care unit after spinal anaesthesia. Regarding disposable material and medicine use, spinal anaesthesia appeared to be more economical and material\u2010sparing than total intravenous anaesthesia. Furthermore, spinal anaesthesia appeared to cause less hypotension requiring haemodynamic interventions than general anaesthesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Editorial Comment<\/jats:title>\n                    <jats:p>This health\u2010economic analysis estimates for how different aspects of general or spinal anaesthesia care contribute to process flow and item costs. Findings suggest that there may be measurably more costs associated with one of the anaesthesia type choices compared with the other, though this will depend on choices for materials and more.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>EudraCT (2016\u2010002035\u201015)<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aas.70359","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:37:26Z","timestamp":1792208246000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Anaesthesia Method on the Use of Anaesthesia Department Resources in Total Knee Arthroplasty"],"prefix":"10.1111","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6806-1277","authenticated-orcid":false,"given":"Katarina","family":"Lahtinen","sequence":"first","affiliation":[{"name":"Anesthesia and Surgery Unit, Peijas Hospital HUS Helsinki University Hospital and University of Helsinki  Vantaa Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2974-9683","authenticated-orcid":false,"given":"Elina","family":"Reponen","sequence":"additional","affiliation":[{"name":"HUS Shared Group Services, HUS Helsinki University Hospital and University of Helsinki  Helsinki Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1470-4397","authenticated-orcid":false,"given":"Noora","family":"Skants","sequence":"additional","affiliation":[{"name":"Anesthesia and Surgery Unit, Peijas Hospital HUS Helsinki University Hospital and University of Helsinki  Vantaa Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"The World Medical Association \u201cWMA Declaration of Geneva \u201daccessed April 8 2026 https:\/\/www.wma.net\/policies\u2010post\/wma\u2010declaration\u2010of\u2010geneva\/."},{"key":"e_1_2_13_3_1","unstructured":"World Health Organization \u201cClimate Change \u201daccessed April 8 2026 https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/climate\u2010change\u2010and\u2010health."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1088\/1748-9326\/ab19e1"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(17)30162-6"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1289\/EHP8666"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31824f6940"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2021.105411"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15785"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/AIA.0b013e3181ea7587"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.06.055"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e058d7"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005102"},{"key":"e_1_2_13_14_1","unstructured":"European Commission \u201cProposal for a Regulation of the European Parliament and of the Council on Fluorinated Greenhouse Gases Amending Directive (EU) 2019\/1937 and Repealing Regulation (EU) No 517\/2014 \u201daccessed April 8 2026 https:\/\/eur\u2010lex.europa.eu\/legal\u2010content\/EN\/TXT\/HTML\/?uri=CELEX:52022PC0150."},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0956-053X(02)00006-5"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1126\/sciadv.1700782"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex098"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckac174"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.03.036"},{"key":"e_1_2_13_20_1","first-page":"1890","article-title":"Use of a Tourniquet and Spinal Anesthesia Increases Satisfactory Outcomes After Total Knee Arthroplasty: A Randomized Study","volume":"103","author":"Rantasalo M.","year":"2021","journal-title":"Journal of Bone and Joint Surgery. 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