{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T11:26:42Z","timestamp":1793964402579,"version":"4.8.0"},"reference-count":63,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T00:00:00Z","timestamp":1791504000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"NHMRC Special Initiative in Human Health and Environmental Change","award":["2008937"],"award-info":[{"award-number":["2008937"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Anaesth Intensive Care"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:p>\n                    Desflurane is a potent greenhouse gas (GHG) and major contributor to healthcare carbon emissions. Clinician-led interventions to reduce its use have been implemented, but their effectiveness has not been systematically reviewed. We aimed to synthesise available evidence on the effectiveness of hospital-based interventions designed to reduce desflurane use. Four databases were searched from inception to 3 July 2025. Randomised and non-randomised controlled trials (RCTs), interrupted time series (ITS) and controlled or uncontrolled before-and-after studies were included. Outcome measures were desflurane consumption (primary), GHG emissions, costs, alternate anaesthetic consumption and staff outcomes. Paired authors independently screened studies, extracted data, assessed risk of bias and certainty of the evidence. Due to heterogeneity, results were synthesised using a structured summary of intervention effects with no meta-analysis. Twenty-three studies were included: 13 uncontrolled before\u2013after studies, seven ITSs and three RCTs. Common interventions were environmental changes (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200920) and education (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200919). No study was rated at low risk of bias across all criteria. All studies that reported impacts on desflurane consumption (17\/17), GHG emissions (16\/16) and costs (14\/14) found reductions. Use of alternative anaesthetics was inconsistent for sevoflurane (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u200915) and isoflurane (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20097) but increased for propofol (\n                    <jats:italic toggle=\"yes\">n<\/jats:italic>\n                    \u2009=\u20097). Staff knowledge (3\/4) and behaviour (3\/3) improved; however, attitudes were unfavourable (1\/1) and acceptability was inconsistent (1\/1). The evidence was very uncertain for all outcomes. Hospital-based interventions targeting desflurane use may reduce consumption, GHG emissions and costs, with inconsistent effects on alternative anaesthetic use and staff outcomes. However, the evidence is very uncertain.\n                  <\/jats:p>","DOI":"10.1177\/0310057x261484168","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T07:10:27Z","timestamp":1791529827000},"page":"506-522","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Interventions to reduce desflurane use in hospitals: A systematic review"],"prefix":"10.1177","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2139-1640","authenticated-orcid":false,"given":"Krista M","family":"Verlis","sequence":"first","affiliation":[{"name":"Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luise","family":"Kazda","sequence":"additional","affiliation":[{"name":"Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"},{"name":"Healthy Environments and Lives (HEAL) Global Research Centre, Health Research Institute, University of Canberra, Canberra, ACT, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra L","family":"Barratt","sequence":"additional","affiliation":[{"name":"Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philomena","family":"Colagiuri","sequence":"additional","affiliation":[{"name":"Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Hull","sequence":"additional","affiliation":[{"name":"Concord Hospital, Sydney Local Health District, Concord, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romi","family":"Haas","sequence":"additional","affiliation":[{"name":"Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1621-3217","authenticated-orcid":false,"given":"Kristen","family":"Pickles","sequence":"additional","affiliation":[{"name":"Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15671"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/jpc.15760"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/bja.2020.06.055"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/anaes.15785"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31824d6150"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(23)00084-0"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005102"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15203"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.09.013"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjane.2021.05.012"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102636"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.08.018"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-025-03605-8"},{"key":"e_1_3_3_15_2","unstructured":"Western Australia Department of Health. Surgery switches to \u2018low carbon\u2019 \u2013 WA Health takes the knife to high-emissions anaesthetic [press release] https:\/\/www.health.wa.gov.au\/Media-releases\/2023\/October\/WA-Health-takes-the-knife-to-high-emissions-anaesthetic (accessed 5 October 2023)."},{"key":"e_1_3_3_16_2","unstructured":"New South Wales Health. Environmental impact of desflurane https:\/\/www.health.nsw.gov.au\/netzero\/Pages\/environmental-impact-desflurane.aspx (accessed 10 October 2024)."},{"key":"e_1_3_3_17_2","unstructured":"Verlis K Kazda L Barratt A et al. Reducing use of desflurane in hospitals: A scoping review [Internet]. Open Science Framework https:\/\/help.osf.io\/article\/221-generate-citations (accessed 6 June 2024)."},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n160"},{"key":"e_1_3_3_19_2","unstructured":"Veritas Health Innovation. Covidence systematic review software. Melbourne Australia www.covidence.org (2025)."},{"key":"e_1_3_3_20_2","unstructured":"Effective Practice and Organisation of Care (EPOC). EPOC taxonomy https:\/\/epoc.cochrane.org\/epoc-taxonomy (accessed 3 June 2024)."},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604.ch8"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD012681.pub2"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(24)00331-0"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0375-9393.23.17767-4"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.11.049"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-23-00402.1"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000037256"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.joclim.2021\/100014"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcorm.2023.100317"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.19224\/ai2020.154"},{"key":"e_1_3_3_32_2","first-page":"109","article-title":"Consumption feedback to reduce inhalation anesthesia costs: a quality improvement project","volume":"40","author":"Shores RT","year":"2022","unstructured":"Shores RT, Meuti KN, Hogan GJT, et al. Consumption feedback to reduce inhalation anesthesia costs: a quality improvement project. Nurs Econ 2022; 40: 109\u2013117.","journal-title":"Nurs Econ"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X1304100116"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000708-2022-001867"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-001867"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003771"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002132"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1013\/ANE.0000000000006172"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-025-2982-7"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006242"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000007375"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006421"},{"key":"e_1_3_3_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10916-02142-x"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00101-006-1059-7"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2009.06081.x"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13825"},{"key":"e_1_3_3_47_2","doi-asserted-by":"publisher","DOI":"10.4103\/singaporemedj.SMJ-2023-256"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1186\/312871-018-0632-3"},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmhebm-2023-112707"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jatmed.2024.10.004"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1607-551X(10)70067-X"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1111\/ans.18770"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.4103\/ija.IJA_413_17"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X19843304"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-022-02393-Z"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1007\/12630-012-9736-2"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.70046"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE\/0b013e31824f6940"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15356"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m865"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1016\/jmayocp.2025.04.012"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.2011.02600.x"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X231212211"}],"container-title":["Anaesthesia and Intensive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X261484168","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0310057X261484168","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0310057X261484168","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T10:55:06Z","timestamp":1793962506000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0310057X261484168"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":63,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1177\/0310057X261484168"],"URL":"https:\/\/doi.org\/10.1177\/0310057x261484168","relation":{},"ISSN":["0310-057X","1448-0271"],"issn-type":[{"value":"0310-057X","type":"print"},{"value":"1448-0271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]}}}