The optimal mode of anaesthesia: are we ready for an evidence-based recommendation?

An environmental impact study compared the carbon footprint of three large French hospitals, one that used >99% total intravenous anaesthesia, one that used target-controlled inhalation anaesthesia, and one that used manually optimised fresh gas flow. We consider these results with previously published environmental impact analyses to determine which mode of anaesthesia is most environmentally friendly. Current understanding in the field following the triple bottom line of 'patient, planet, profit' informs an evidence-based recommendation around the optimal default mode of anaesthesia.