{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:39:20Z","timestamp":1791571160943,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["2008937"],"award-info":[{"award-number":["2008937"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001136","name":"Australian and New Zealand College of Anaesthetists","doi-asserted-by":"publisher","award":["Research Scholarship"],"award-info":[{"award-number":["Research Scholarship"]}],"id":[{"id":"10.13039\/501100001136","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Medical Journal of Australia"],"published-print":{"date-parts":[[2025,12,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To assess changes in greenhouse gas emission rates associated with the use of anaesthetic gases (desflurane, sevoflurane, and isoflurane) in Australian health care during 2002\u20132022, overall and by state or territory and hospital type.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Retrospective descriptive analysis of IQVIA anaesthetic gases purchasing data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>All Australian public and private hospitals, 1 January 2002 \u2013 31 December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      Absolute carbon dioxide equivalent (CO\n                      <jats:sub>2<\/jats:sub>\n                      e) emissions and CO\n                      <jats:sub>2<\/jats:sub>\n                      e emissions rate per 100\u2009000 population by gas and year, overall and by state\/territory and hospital type (public or private).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The overall emissions rate increased from 74\u2009t CO\n                      <jats:sub>2<\/jats:sub>\n                      e per 100\u2009000 population in 2002 to 328\u2009t CO\n                      <jats:sub>2<\/jats:sub>\n                      e per 100\u2009000 population in 2012, most rapidly during 2002\u20132004 (annual percentage change [APC], 51%; 95% confidence interval [CI], 38\u201362%). The rate then declined to 83\u2009t CO\n                      <jats:sub>2<\/jats:sub>\n                      e per 100\u2009000 population in 2022, most rapidly during 2017\u20132022 (APC, \u201321%; 95% CI, \u201323% to \u201320%). Patterns of emissions rate change were similar for all states and territories. More units of sevoflurane than of desflurane or isoflurane were purchased each year throughout 2002\u20132022, but desflurane provided the largest proportion of total emissions from anaesthetic gases during 2002\u20132022: 33% in 2002, 88% in 2013, and 68% in 2022. Mean emission rates per 100\u2009000 population during 2002\u20132022 were highest for South Australia\/Northern Territory (276\u2009t CO\n                      <jats:sub>2<\/jats:sub>\n                      e per year) and lowest for Victoria\/Tasmania (196\u2009t CO\n                      <jats:sub>2<\/jats:sub>\n                      e per year). The desflurane emissions rate was consistently higher for private than public hospitals; it declined for public hospitals during 2009\u20132018 (APC, \u20138%; 95% CI, \u201310% to \u20135%) and 2018\u20132022 (APC, \u201343%; 95% CI, \u201348% to \u201337%), but for private hospitals only during 2017\u20132022 (APC, \u201320%; 95% CI, \u201324% to \u201317%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      In Australia, the CO\n                      <jats:sub>2<\/jats:sub>\n                      e emissions rate for anaesthetic gases increased during 2002\u20132008 but declined during 2017\u20132022, at first primarily in public hospitals. Continuing to reduce the use of anaesthetic gases, particularly desflurane, will advance the decarbonisation of clinical practice in Australian health care.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.5694\/mja2.70046","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T09:29:40Z","timestamp":1757323780000},"page":"570-575","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Greenhouse gas emissions associated with anaesthetic gases in Australia, 2002\u20132022: a retrospective descriptive analysis"],"prefix":"10.5694","volume":"223","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2139-1640","authenticated-orcid":false,"given":"Krista","family":"Verlis","sequence":"first","affiliation":[{"name":"Sydney School of Public Health the University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica F","family":"Davies","sequence":"additional","affiliation":[{"name":"Austin Health  Melbourne VIC"},{"name":"The University of Melbourne  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1977-9072","authenticated-orcid":false,"given":"Forbes","family":"McGain","sequence":"additional","affiliation":[{"name":"The University of Melbourne  Melbourne VIC"},{"name":"Western Health  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8191-6066","authenticated-orcid":false,"given":"Hayden","family":"Burch","sequence":"additional","affiliation":[{"name":"Austin Health  Melbourne VIC"},{"name":"The University of Melbourne  Melbourne VIC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra L","family":"Barratt","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health the University of Sydney  Sydney NSW"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4105-0402","authenticated-orcid":false,"given":"Luise","family":"Kazda","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health the University of Sydney  Sydney NSW"},{"name":"Health Research Institute University of Canberra  Canberra ACT"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,8]]},"reference":[{"key":"e_1_2_10_1_1","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15671"},{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000005504"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(17)30162-6"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.2344\/0003-3006-59.4.154"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2023.101291"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X19836104"},{"key":"e_1_2_10_7_1","article-title":"a decade of advances","author":"McDonald J.","year":"1974","journal-title":"Australian Society of Anaesthetists"},{"key":"e_1_2_10_8_1","unstructured":"Therapeutic Goods Administration (Australian Department of Health and Aged Care).SEVORANE sevoflurane anaesthetic inhalation bottle (ARTG ID 51919). 4 Jan1996.https:\/\/www.tga.gov.au\/resources\/artg\/51919(viewed Oct 2024)."},{"key":"e_1_2_10_9_1","unstructured":"Therapeutic Goods Administration (Australian Department of Health and Aged Care).SUPRANE desflurane 1g\/g inhalation USP bottle (ARTG ID 60909). 20 Aug1997.https:\/\/www.tga.gov.au\/resources\/artg\/60909(viewed Oct 2024)."},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199651040-00009"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(23)00084-0"},{"key":"e_1_2_10_12_1","unstructured":"Eurostat.Carbon dioxide equivalent. In: European Environmental Agency Glossary. 10 Aug2023.https:\/\/ec.europa.eu\/eurostat\/statistics\u2010explained\/index.php?title=Glossary: Carbon_dioxide_equivalent (viewed Jan 2025)."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeq259"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.15785"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/2014GL062785"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2023.08.018"},{"key":"e_1_2_10_17_1","unstructured":"NSW Health.Environmental impact of desflurane. 28 Feb2024.https:\/\/www.health.nsw.gov.au\/netzero\/Pages\/environmental\u2010impact\u2010desflurane.aspx(viewed Oct 2024)."},{"key":"e_1_2_10_18_1","unstructured":"Department of Health (Western Australia).Surgery switches to \u201clow carbon\u201d: WA Health takes the knife to high\u2010emissions anaesthetic [media release]. 5 Oct2023.https:\/\/www.health.wa.gov.au\/Media\u2010releases\/2023\/October\/WA\u2010Health\u2010takes\u2010the\u2010knife\u2010to\u2010high\u2010emissions\u2010anaesthetic(viewed Oct 2024)."},{"key":"e_1_2_10_19_1","unstructured":"Australian Private Hospital Association.Federal budget submission 2019\u201320. 24 Aug2020.https:\/\/treasury.gov.au\/sites\/default\/files\/2020\u201009\/115786_AUSTRALIAN_PRIVATE_HOSPITALS_ASSOCIATION_\u2010_SUBMISSION_2.pdf(viewed Oct 2024)."},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-001867"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12871-018-0632-3"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885"},{"key":"e_1_2_10_23_1","unstructured":"Australian Bureau of Statistics.National state and territory population December2024. 19 June 2025.https:\/\/www.abs.gov.au\/statistics\/people\/population\/national\u2010state\u2010and\u2010territory\u2010population\/latest\u2010release(viewed Sept 2024)."},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.9407"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(17)30180-8"},{"key":"e_1_2_10_26_1","unstructured":"Australian and New Zealand College of Anaesthetists.ANZCA statement on desflurane. Nov2024.https:\/\/www.anzca.edu.au\/resources\/environmental\u2010sustainability\/anzca\u2010statement\u2010on\u2010desflurane\u20102024.pdf(viewed Aug 2024)."},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X221102469"},{"key":"e_1_2_10_28_1","unstructured":"Australian Institute of Health and Welfare.Hospitals at a glance (here: table\u00a03). Updated 13 May2025.https:\/\/www.aihw.gov.au\/reports\/hospitals\/australias\u2010hospitals\u2010at\u2010a\u2010glance(viewed Aug 2025)."},{"key":"e_1_2_10_29_1","unstructured":"Ramsay Health Care.Caring for our planet. Undated.https:\/\/www.ramsayhealth.com\/en\/sustainability\/caring\u2010for\u2010our\u2010planet(viewed Sept 2024)."},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002132"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003771"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006172"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006421"},{"key":"e_1_2_10_34_1","first-page":"154","article-title":"Der CO2\u2010Fu\u00dfabdruck der An\u00e4sthesie. Wie die Wahl volatiler An\u00e4sthetika die CO2\u2010Emissionen einer an\u00e4sthesiologischen Klinik beeinflusst","volume":"61","author":"Richter H","year":"2020","journal-title":"An\u00e4sth Intensivmed"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.4300\/JGME-D-23-00402.1"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006242"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.06.055"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1177\/0310057X19884075"},{"key":"e_1_2_10_39_1","unstructured":"Australian Department of Health and Aged Care.National health and climate strategy. 3 Dec2023.https:\/\/www.health.gov.au\/resources\/publications\/national\u2010health\u2010and\u2010climate\u2010strategy?language=en(viewed July 2024)."},{"key":"e_1_2_10_40_1","unstructured":"Australian Commission on Safety and Quality in Healthcare.Environmental sustainability and climate resilience healthcare module. Updated 8 Nov2024.https:\/\/www.safetyandquality.gov.au\/standards\/environmental\u2010sustainability\u2010and\u2010climate\u2010resilience\u2010healthcare\u2010module(viewed Oct 2024)."}],"container-title":["Medical Journal of Australia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.5694\/mja2.70046","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T08:34:42Z","timestamp":1765182882000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.5694\/mja2.70046"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":40,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,12,8]]}},"alternative-id":["10.5694\/mja2.70046"],"URL":"https:\/\/doi.org\/10.5694\/mja2.70046","archive":["Portico"],"relation":{},"ISSN":["0025-729X","1326-5377"],"issn-type":[{"value":"0025-729X","type":"print"},{"value":"1326-5377","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]},"assertion":[{"value":"2024-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-08","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}