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
Authors' 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.
Study context
- Population
- Surgical cases of consecutive patients older than 5 years, tertiary Belgian hospital
- Participants
- 11,909 consecutive patients
- Exposure
- Total intravenous anaesthesia (TIVA) vs sevoflurane maintenance of anaesthesia
- Outcome
- Economic cost and CO 2 e emissions of scenarios for maintenance of anaesthesia (local tender prices, lifecycle assessment of drugs and disposables)
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
CO 2 e emissions and costs per 1000 procedures
| Group | Value | Cost |
|---|---|---|
| TIVA | 963 kg | €4300 |
| Minimal-flow sevoflurane | 25 562 kg | €6772 |
| Sevoflurane 2 l min −1 fresh gas flow (FGF) | 59 483 kg | €11 933 |
Value
TIVA963 kg
Minimal-flow sevoflurane25 562 kg
Sevoflurane 2 l min −1 fresh gas flow (FGF)59 483 kg
Cost
TIVA€4300
Minimal-flow sevoflurane€6772
Sevoflurane 2 l min −1 fresh gas flow (FGF)€11 933
- Minimal-flow sevoflurane CO 2 e vs TIVA
- 26.5 times more
- Sevoflurane 2 l min −1 FGF CO 2 e vs TIVA
- 61.8 times more
- TIVA cost as share of sevoflurane cost, minimal flow and 2 l min −1 FGF respectively
- 36% and 63%
Observational data: associations, not effects.
Original publication
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. Eur J Anaesthesiol. Published 23 December 2025. doi:10.
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