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Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA\u2010volatile strategy. This comparative retrospective study was conducted over 2\u2009years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42\u2009kg vs. 48.85\u2009kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk\u2013benefit ratio of the widespread adoption of total intravenous anaesthesia.<\/jats:p>","DOI":"10.1111\/anae.16221","type":"journal-article","created":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T04:04:26Z","timestamp":1704945866000},"page":"309-317","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients"],"prefix":"10.1111","volume":"79","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3520-9392","authenticated-orcid":false,"given":"M.","family":"Bernat","sequence":"first","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine H\u00f4pital de la Conception, Assistance Publique des H\u00f4pitaux de Marseille, Aix Marseille University  Marseille 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