Bernat Matthieu, Cuvillon Philippe, Brieussel Thomas, Roche Manon, Remacle Anne, Leone Marc, Lukaszewicz Anne-Claire, Bouvet Lionel, Zieleskiewicz Laurent
Department of Anaesthesia and Intensive Care Medicine, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France.
Department of Anaesthesia and Intensive Care, CHU Carémeau, Nîmes, France.
Br J Anaesth. 2025 Jun;134(6):1620-1627. doi: 10.1016/j.bja.2025.01.043. Epub 2025 Apr 4.
General anaesthesia is a significant contributor to healthcare-related greenhouse gas (GHG) emissions. Previous studies have compared non-optimised anaesthesia strategies (desflurane, nitrous oxide, or both) to evaluate the impact of green initiatives on reducing the carbon footprint of anaesthesia. However, modern halogenated anaesthesia techniques, including low fresh gas flow and target-controlled inhalation anaesthesia (TCIA), offer potentially more environmentally friendly alternatives. Thus, we aimed to compare the GHG emissions of total intravenous anaesthesia (TIVA) with these newer techniques.
This multicentre study compared GHG emissions per hour of general anaesthesia in adult surgical patients between three anaesthetic strategies: TIVA with propofol, sevoflurane in TCIA mode, and manually optimised sevoflurane. The study was conducted in three French university hospitals, each using one anaesthesia strategy. The quantity of anaesthetic drugs used was obtained from pharmacy procurement records and converted to carbon dioxide equivalents (COe). The primary outcome was the total GHG emissions per hour of anaesthesia for each strategy, including sevoflurane, propofol, and syringe consumption.
TCIA, manually optimised sevoflurane, and TIVA strategies were used in 7873, 15 461, and 10 717 anaesthetics, respectively. The carbon footprint of the principal anaesthetic drugs per hour of anaesthesia was significantly lower in the TIVA strategy, at 0.4 kg COe per hour, compared with 3.1 kg COe per hour in the TCIA strategy and 3.8 kg COe per hour in the manually optimised sevoflurane strategy.
TIVA with propofol was the most effective approach for minimising greenhouse gas emissions in anaesthesia practices. However, if TIVA were used exclusively globally, it could lead to issues such as stock depletion, plastic pollution, and water contamination.
全身麻醉是医疗相关温室气体（GHG）排放的一个重要来源。以往的研究比较了未优化的麻醉策略（地氟烷、氧化亚氮或两者皆用），以评估绿色举措对减少麻醉碳足迹的影响。然而，现代卤化麻醉技术，包括低新鲜气体流量和靶控吸入麻醉（TCIA），提供了可能更环保的替代方案。因此，我们旨在比较全静脉麻醉（TIVA）与这些较新技术的温室气体排放。
这项多中心研究比较了三种麻醉策略下成年外科手术患者全身麻醉每小时的温室气体排放：丙泊酚全静脉麻醉、TCIA模式下的七氟烷麻醉以及手动优化的七氟烷麻醉。该研究在三家法国大学医院进行，每家医院采用一种麻醉策略。使用的麻醉药物数量从药房采购记录中获取，并转换为二氧化碳当量（COe）。主要结局是每种策略每小时麻醉的温室气体总排放量，包括七氟烷、丙泊酚和注射器消耗。
分别有7873例、15461例和10717例麻醉采用了TCIA、手动优化的七氟烷和TIVA策略。TIVA策略每小时麻醉主要麻醉药物的碳足迹显著更低，为每小时0.4千克COe，而TCIA策略为每小时3.1千克COe，手动优化的七氟烷策略为每小时3.8千克COe。
丙泊酚全静脉麻醉是麻醉实践中减少温室气体排放的最有效方法。然而，如果在全球范围内仅使用TIVA，可能会导致库存耗尽、塑料污染和水污染等问题。
