Intravenous anesthesia greatly reduces CO₂ emissions: Comparable to annual emissions of Denmark

What if you could save 98% of CO₂ emissions during surgery with just one change? And what if that change also improved patient recovery and saved costs? Then you'd probably want to implement that adjustment as quickly as possible, preferably worldwide.

That is the mission of Amsterdam UMC anesthesiologist Niek Sperna Weiland. "Our relatively small professional group can ultimately achieve a worldwide reduction in CO₂ emissions that is as large as the annual emissions of all of Denmark." The adjustment in question: intravenous anesthesia, instead of an anesthetic gas.

"Three different anesthetic gases are used to anesthetize patients for surgery: sevoflurane, isoflurane and desflurane," explains Sperna Weiland.

"These are so-called F-gases, strong greenhouse gases that are used in cooling systems, for example, and that together cause about 5% of global warming. The anesthetic gases retain much more heat than CO₂: sevoflurane is 500 times stronger than CO₂, desflurane even 7,000 times." The alternative is much more environmentally friendly: intravenous anesthesia, anesthesia via an infusion.

"By switching from desflurane to intravenous anesthesia, you save 98% of CO₂ emissions. Switching from sevoflurane—the least harmful anesthetic gas—to intravenous saves 80%."

Less nausea and less confusion

Desflurane and isoflurane have now virtually disappeared from Dutch clinical practice and sevoflurane is also used less and less. This is the result of the efforts of Sperna Weiland and his team.

"Our research showed that two conditions are essential for our colleagues: patient safety and professional autonomy. There should be no doubt about the first. Ph.D. candidate Jasper Kampman therefore conducted a meta-analysis of the studies that compared the effects of intravenous anesthesia with those of anesthesia with anesthetic gases.

"This showed that there is no difference in terms of patient safety and that intravenous anesthesia does not lead to more complications. On the contrary, after anesthesia via an IV, people are less nauseous and less confused. This ensures a better recovery. Because patients spend less time in the recovery room and need less medication for nausea, it's also cheaper."

Intravenous as first choice

Strengthened by these scientific insights, and now with a subsidy for further national implementation, Sperna Weiland and Kampman went looking for reinforcement to spread the message more widely. "Together with specialists in the field of communication and behavioral change, we set up a campaign for anesthesiologists, under the slogan 'Intravenous, if possible, gas if necessary.'"

The guidelines of the Dutch Anesthesiology Society have also been adjusted. "Every professional group must now have a protocol stating that intravenous anesthesia is the first choice. Anesthesiologists can add a list of indications for vapor anesthesia to this protocol at their own discretion, because for some patients this remains necessary."

Political urgency

The figures and arguments that Sperna Weiland and colleagues listed did not go unnoticed by policymakers. For example, "Anesthetizing differently' became one of the measures in the 54 Point Plan, the guideline from the environmental organization Urgenda to the Dutch government to achieve a 25% CO₂ reduction in 2025.

A recent milestone is the new European F-gas legislation that will come into effect on 1 January 2026. "In this, the use of desflurane is subject to so many rules and administration that it is virtually banned," says Sperna Weiland. "The fact that this is possible for a medicine that works well in itself, based solely on environmental arguments, is unique."

Impact in China

The anesthesiologist has now traveled to the Chinese National Health Committee in Beijing twice with a delegation from the Dutch Ministry of Health, Welfare and Sport. "China is already struggling with the consequences of global warming and enormous steps are being taken in the energy transition. Our project can therefore be well-received there.

"I am struck by how open our colleagues are to it. With great potential impact: in the Netherlands there are approximately 2,500 anesthesiologists, in China there are 112,000 in 35,000 hospitals. Only on that scale can we really make a difference. Because 97% of anesthesiologists in China are not yet aware of the climate impact, we will first have all available scientific information translated into Chinese."

Provided by Amsterdam University Medical Centers