{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:19:59Z","timestamp":1790806799515,"version":"4.1.0"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The carbon footprint of propofol is less than that of sevoflurane per minimum alveolar concentration hour equivalent of drug, but there are justifiable concerns about the amount of clinical waste generated during\u00a0total intravenous anaesthesia (TIVA), especially in the context of shorter procedures. The aim of this study was to assess the carbon footprint of inhalational sevoflurane anaesthesia vs. TIVA with propofol and remifentanil, including all the consumables used, over the first 6\u2009h of general anaesthesia in adult patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hybrid approach was used to model 10 scenarios: intravenous induction followed by inhalational sevoflurane maintenance with five levels of sevoflurane consumption; and five TIVA scenarios with different combinations of low, moderate and high doses of propofol and remifentanil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      For the first 22\u2009min, the median consumption sevoflurane scenario had a lower estimated carbon footprint than all TIVA scenarios, beyond which all TIVA scenarios had a lower carbon footprint. Beyond 44\u2009min, all sevoflurane scenarios had higher carbon footprints than all the TIVA scenarios. For every hour of general anaesthesia beyond 22\u2009min, the carbon footprint of the moderate dose TIVA scenario increased by 0.04\u20130.60 kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e.h\n                      <jats:sup>\u20101<\/jats:sup>\n                      , compared with 4.01 kgCO\n                      <jats:sub>2<\/jats:sub>\n                      e.h\n                      <jats:sup>\u20101<\/jats:sup>\n                      for the median consumption sevoflurane scenario. Hotspot analysis of the moderate dose TIVA and median consumption sevoflurane scenarios showed that the consumables used in TIVA contributed most to the estimated overall carbon footprint of this technique (50.9\u201360.4%), followed by drugs (39.6\u201345.4%). In the sevoflurane scenario, sevoflurane was the greatest contributor to the carbon footprint, eventually being responsible for 99.5% of the total footprint at 360\u2009min.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adopting TIVA for appropriate cases lasting longer than 22\u2009min will reduce the carbon footprint of general anaesthesia compared with median consumption of sevoflurane general anaesthesia. Using low fresh gas flows or end\u2010tidal control reduces the carbon footprint of inhalational general anaesthesia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70023","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T12:18:43Z","timestamp":1760444323000},"page":"332-342","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Carbon footprint of total intravenous anaesthesia vs. inhalational sevoflurane anaesthesia in adults: a modelling\u00a0study"],"prefix":"10.1111","volume":"81","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-8710-5674","authenticated-orcid":false,"given":"Becca","family":"Elson","sequence":"first","affiliation":[{"name":"Anaesthetics Department East Suffolk and North Essex NHS Foundation Trust  Colchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingeborg","family":"Steinbach","sequence":"additional","affiliation":[{"name":"Centre for Sustainable Healthcare  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosie","family":"Hillson","sequence":"additional","affiliation":[{"name":"Centre for Sustainable Healthcare  Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(21)01915\u20102"},{"key":"e_1_2_6_3_1","unstructured":"NHS England.Delivering a \u2018Net Zero\u2019 National Health Service.2020.https:\/\/www.england.nhs.uk\/greenernhs\/wp\u2010content\/uploads\/sites\/51\/2022\/07\/B1728\u2010delivering\u2010a\u2010net\u2010zero\u2010nhs\u2010july\u20102022.pdf(accessed 7 June 2024)."},{"key":"e_1_2_6_4_1","unstructured":"World Health Organization.Climate change 2023.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/climate\u2010change\u2010and\u2010health(accessed May 7 2024)."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(23)02466\u20102"},{"key":"e_1_2_6_6_1","unstructured":"WattsN MoonesingheR ForemanC.Putting anaesthetic emissions to bed: commitment on desflurane.2023. NHS England.https:\/\/www.england.nhs.uk\/blog\/putting\u2010anaesthetic\u2010emissions\u2010to\u2010bed\/(accessed May 7 2024)."},{"key":"e_1_2_6_7_1","unstructured":"Royal College of Anaesthetists Association of Anaesthetists College of Anaesthesiologists of Ireland Obstetric Anaesthetists' Association Association of Paediatric Anaesthetists of Great Britain and Ireland.Consensus Statement on the Removal of Pipeline Nitrous Oxide in the United Kingdom and Republic of Ireland.2024.https:\/\/www.rcoa.ac.uk\/sites\/default\/files\/documents\/2024\u201007\/Consensus%20statement%20on%20removal%20of%20pipeline%20nitrous%20oxide.pdf(accessed 7 June 2025)."},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16407"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31824f6940"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2021.105411"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2021.03.004"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2022.04.022"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15356"},{"key":"e_1_2_6_14_1","unstructured":"NHS Health Research Authority Medical Research Council.Is my study research?2022.https:\/\/www.hra\u2010decisiontools.org.uk\/research\/index.html(accessed January 21 2025)."},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10877\u2010022\u201000961\u20108"},{"key":"e_1_2_6_16_1","unstructured":"National Institute for Health and Care Excellence.British National Formulary. Updated 2025."},{"key":"e_1_2_6_17_1","unstructured":"Baxter Healthcare Ltd.Propofol 20 mg\/ml Emulsion for injection\/infusion \u2013 Summary of Product Characteristics. Electronic Medicines Compendium 2022.https:\/\/www.medicines.org.uk\/emc\/product\/11294\/smpc#gref(accessed September 15 2023)."},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.05.051"},{"key":"e_1_2_6_19_1","unstructured":"Aspen.Remifentanil 2 mg powder for concentrate for solution for injection\/infusion \u2013 Summary of Product Characteristics. Electronic Medicines Compendium 2022.https:\/\/www.medicines.org.uk\/emc\/product\/795\/smpc(accessed September 15 2023)."},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15501"},{"key":"e_1_2_6_21_1","unstructured":"BarrowM BuckleyB CaldicottT CumberlegeT HsuJ KaufmanS et\u00a0al.Greenhouse Gas Protocol Technical Guidance for Calculating Scope 3 Emissions (version 1.0).2013.https:\/\/ghgprotocol.org\/sites\/default\/files\/ghgp\/standards\/Scope3_Calculation_Guidance_0.pdf(accessed 22 July 2024)."},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/europace\/euac160"},{"key":"e_1_2_6_23_1","unstructured":"Department for Energy Security and Net Zero.Greenhouse gas reporting: conversion factors 2024.2024. GOVUK.https:\/\/www.gov.uk\/government\/publications\/greenhouse\u2010gas\u2010reporting\u2010conversion\u2010factors\u20102024(accessed 22 July 2024)."},{"key":"e_1_2_6_24_1","unstructured":"JonesC HammondG.Inventory of Carbon and Energy (ICE) Database V3.0 2019.https:\/\/circularecology.com\/news\/ice\u2010database\u2010v3\u2010launched(accessed 10 March 2023)."},{"key":"e_1_2_6_25_1","volume-title":"Carbon Factors Dataset version 5.3 [database]","author":"Small World Consulting","year":"2020"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1021\/acssuschemeng.8b05473"},{"key":"e_1_2_6_27_1","unstructured":"Department for Environment Food & Rural Affairs.Conversion factors KgCO2per \u00a3 spent by SIC code 2021.2024.https:\/\/www.gov.uk\/government\/statistics\/uks\u2010carbon\u2010footprint(accessed 17 July 2024)."},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclepro.2020.125446"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16221"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102636"},{"key":"e_1_2_6_31_1","volume-title":"Care Pathways: Guidance on Appraising Sustainability, Inpatient Bed Day Module","author":"Coalition for Sustainable Pharmaceuticals and Medical Devices","year":"2015"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/EJA.0000000000002175"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16189"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.16119"},{"key":"e_1_2_6_35_1","volume-title":"Understanding climate\u2010related threats to health in the WHO European Region","author":"Blom I","year":"2025"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542\u20105196(21)00278\u20103"},{"key":"e_1_2_6_37_1","unstructured":"GroomeJ LewisH Young People's Forum (YPF).Our anaesthetic and our future \u2013 collaborating with children to reduce healthcare's carbon footprint. APA poster 2021."},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15989"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10916\u2010020\u201001634\u20102"},{"key":"e_1_2_6_40_1","unstructured":"PflegerS.Anaesthesia \u2013 is it really pain free for the environment?Anaesthesia News Digital2022.https:\/\/anaesthetists.org\/Home\/Resources\u2010publications\/Anaesthesia\u2010News\u2010magazine\/Anaesthesia\u2010News\u2010Digital\u2010February\u20102022\/Anaesthesia\u2010is\u2010it\u2010really\u2010pain\u2010free\u2010for\u2010the\u2010environment(accessed 7 May 2024)."},{"key":"e_1_2_6_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2024.12.002"}],"container-title":["Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70023","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/anae.70023","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/anae.70023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T02:31:33Z","timestamp":1774665093000},"score":1,"resource":{"primary":{"URL":"https:\/\/associationofanaesthetists-publications.onlinelibrary.wiley.com\/doi\/10.1111\/anae.70023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":40,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1111\/anae.70023"],"URL":"https:\/\/doi.org\/10.1111\/anae.70023","archive":["Portico"],"relation":{},"ISSN":["0003-2409","1365-2044"],"issn-type":[{"value":"0003-2409","type":"print"},{"value":"1365-2044","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"2025-07-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-14","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}