Environmental and economic impacts of anaesthesia: A simulation study comparing total intravenous anaesthesia versus sevoflurane for maintenance of anaesthesia in 11 909 adult patients of a Belgian tertiary hospital.

BACKGROUND

Total intravenous anaesthesia (TIVA) is widely recognised as a less environmentally harmful alternative to volatile anaesthesia. However, TIVA is often perceived as a more expensive technique, raising questions about its cost-effectiveness in routine practice.

OBJECTIVE

This study models the environmental impact and cost-effectiveness of TIVA versus sevoflurane anaesthesia.

DESIGN

Retrospective simulation-based observational study.

PATIENTS: Surgical cases of 11 909 consecutive patients, older than 5 years, observed in a tertiary Belgian hospital.

INTERVENTION: The economic cost and carbon dioxide equivalent (CO 2 e) emissions of maintenance using sevoflurane versus propofol of anaesthesia were calculated, using local tender prices and the lifecycle assessment for all drugs and disposable materials involved in each scenario.

MAIN OUTCOME MEASURE: The economic cost and CO 2 e emissions of different scenarios for maintenance of anaesthesia.

RESULTS

For every 1000 procedures, CO 2 e emissions and costs were: TIVA - 963 kg at a cost of €4300; minimal-flow sevoflurane - 25 562 kg at a cost of €6772; sevoflurane [2 l min -1 fresh gas flow (FGF)] - 59 483 kg at a cost of €11 933.

CONCLUSION

Our simulations indicate that minimal flow sevoflurane produces 26.5 times more CO 2 e than TIVA, rising to 61.8 times more at 2 l min -1 FGF. TIVA also costs significantly less, at 36% and 63% of sevoflurane anaesthesia costs with minimal flow and 2 l min -1 FGF, respectively.These findings highlight not only TIVA's marked superiority in reducing carbon emissions but also its notable cost advantages over traditional volatile anaesthetic methods. The stark contrast in emissions - where TIVA produces just a fraction of the CO 2 e compared to even the most environmentally conscious sevoflurane protocols - underscores the critical role anaesthetic choice plays in healthcare sustainability. Moreover, the substantial difference in costs challenges the prevailing perception that TIVA is prohibitively expensive. As hospitals worldwide face mounting pressure to align clinical practices with environmental stewardship, these results advocate for a critical reassessment of routine anaesthetic protocols.