On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia

Riedel, Bernhard; Dubowitz, Julia; Yeung, Joyce; Jhanji, Shaman; Kheterpal, Sachin; Avidan, Michael S.

doi:10.1016/j.bja.2022.06.008

Cited by 10 publications

(7 citation statements)

References 25 publications

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“…To mitigate the carbon footprint associated with paediatric inhaled anaesthesia, the SPRUCE project proposed three action‐oriented approaches: educational initiatives; practice restrictions; and data analysis to develop protocols and feedback mechanisms [26]. Our findings align with these proposals, as they include educational programs implemented by the operating theatre sustainability task force within the TIVA strategy hospital, such as removing desflurane vaporisers and the continuous monitoring of carbon emissions related to anaesthesia [18].…”

Section: Discussionmentioning

confidence: 64%

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Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

Bernat,

Boyer,

Roche

et al. 2024

Anaesthesia

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SummaryGlobal warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. 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‐volatile strategy. This comparative retrospective study was conducted over 2 years 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 kg vs. 48.85 kg 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–benefit ratio of the widespread adoption of total intravenous anaesthesia.

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Section: Discussionmentioning

confidence: 64%

“…Anaesthetists at this hospital are trained to provide TIVA, with only a few emergency exceptions permitted by the local protocol, e.g. bronchospasm or loss of venous access [18]. In this centre, > 99% of procedures are conducted using TIVA (online Supporting Information Appendix S1).…”

Section: Methodsmentioning

confidence: 99%

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

Bernat,

Boyer,

Roche

et al. 2024

Anaesthesia

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“…2 However, although women in labour maintain capacity and act in their own volition, the third element of consent -'sufficient information', is not consistently available. 3 This gives rise to ethical challenges and has potential medicolegal implications.…”

Section: Postnatal Recall Of Epidural Information Compared Between Pa...mentioning

confidence: 99%

“…Propofol-based TIVA has been gaining popularity in the last decade because of several benefits over inhalational anaesthesia 3 . There is consistent evidence of a reduction in postoperative nausea and vomiting (PONV) and improved recovery indicators, including postoperative pain, patient satisfaction, and duration of PACU stay 4,5 .…”

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confidence: 99%

Availability of total intravenous anaesthesia for obstetric surgery

Scale,

Johnson-Hughes,

Metodiev

2023

European Journal of Anaesthesiology

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“…With the discovery of volatile anesthetics in the nineteenth century, surgeons were finally able to perform procedures on patients who were unresponsive to the surgical pain [ 4 ]. At present, there are two main techniques for delivering general anesthesia: volatile/inhaled anesthesia and total intravenous anesthesia [ 5 ]. Opioids were introduced to the anesthesia practice as a method of decreasing the amount of volatile anesthetic necessary for surgical anesthesia, thereby decreasing the risk of toxic side effects from volatile agents [ 4 ].…”

mentioning

confidence: 99%