{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T20:59:30Z","timestamp":1789592370068,"version":"build-2803163510"},"reference-count":43,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"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":[[2026,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The UK NHS is committed to reaching net zero carbon emissions by 2040. Volatile anaesthetic agents are potent greenhouse gases and alternative intravenous methods exist. We aimed to predict the cost\u2010effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon emissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A general anaesthetic for a 40\u2010year\u2010old, 78\u2010kg patient was modelled. Two volatile anaesthetic agents (desflurane and sevoflurane) were compared with propofol\u2010remifentanil total intravenous anaesthesia. Total intravenous anaesthesia with and without processed electroencephalography was modelled. Cost\u2010effectiveness was calculated as the cost per kg carbon dioxide equivalent saved by transition to total intravenous anaesthesia, benchmarked against the UK emission trading scheme carbon permit price of \u00a341.84 (US$54.90, \u20ac47.28) per tonne carbon dioxide equivalent.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Total intravenous anaesthesia was less carbon intensive than sevoflurane and desflurane (2.0 vs. 9.8\u2009kg and 209.2\u2009kg carbon dioxide equivalent, respectively). Total intravenous anaesthesia was more expensive than sevoflurane when processed electroencephalography was used (\u00a313.03 (US$17.08, \u20ac14.72) vs. \u00a39.76 (US$12.79, \u20ac11.03)) but cheaper when it was not (\u00a35.31 (US$6.95, \u20ac6.00) vs. \u00a39.76 (US$12.79, \u20ac11.03)). When processed electroencephalography was used, the incremental cost\u2010effectiveness ratio of transitioning from sevoflurane to total intravenous anaesthesia was \u00a3416 (US$544, \u20ac470) per tonne carbon dioxide equivalent. Total intravenous anaesthesia (with and without processed electroencephalography) was cheaper than desflurane (\u00a318.94 (US$24.77, \u20ac21.41)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Using our model parameters and the different carbon dioxide emissions and similar cost, transitioning from desflurane anaesthesia to total intravenous anaesthesia is cost\u2010effective. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia without processed electroencephalography is likely to be cost\u2010effective but is not recommended due to the increased risk of awareness. Transitioning from sevoflurane anaesthesia to total intravenous anaesthesia with processed electroencephalography is unlikely to be cost\u2010effective.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/anae.70111","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T09:27:29Z","timestamp":1768382849000},"page":"675-684","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Cost\u2010effectiveness of a transition from volatile anaesthesia to total intravenous anaesthesia to reduce carbon footprint: an economic modelling study"],"prefix":"10.1111","volume":"81","author":[{"given":"Daniel","family":"Leslie","sequence":"first","affiliation":[{"name":"Theatres and Anaesthetics, Imperial College Healthcare NHS Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4502-333X","authenticated-orcid":false,"given":"Christopher J.","family":"Mullington","sequence":"additional","affiliation":[{"name":"Theatres and Anaesthetics, Imperial College Healthcare NHS Trust  London UK"},{"name":"Department of Anaesthetics Pain Medicine and Intensive Care, Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,14]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"NHS England and NHS Improvement.Delivering a \u201cNet Zero\u201d National Health Service.2022.https:\/\/www.england.nhs.uk\/greenernhs\/wp\u2010content\/uploads\/sites\/51\/2022\/07\/B1728\u2010delivering\u2010a\u2010net\u2010zero\u2010nhs\u2010july\u20102022.pdf(accessed 22\/10\/2022)."},{"key":"e_1_2_6_3_1","unstructured":"Royal College of Anaesthetists.At the Heart of the Matter Report and Findings of the 7th National Audit Project of the Examining Perioperative Cardiac Arrest.2023.https:\/\/www.rcoa.ac.uk\/media\/42071(accessed 19\/11\/2025)."},{"key":"e_1_2_6_4_1","unstructured":"Royal College of Anaesthetists.Sustainability Strategy 2019\u20132022.https:\/\/www.rcoa.ac.uk\/about\u2010college\/strategy\u2010vision\/environment\u2010sustainability\/sustainability\u2010strategy\u20102019\u20102022(accessed 31\/12\/2022)."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0B013E31824D6150"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ANAE.12826"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ANAE.14853"},{"key":"e_1_2_6_8_1","unstructured":"National Institute for Health and Care Excellence.Guide to the methods of technology appraisal. 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