Assessing the carbon footprint of inhalation anaesthesia, total intravenous anaesthesia, and spinal anaesthesia for a single surgical procedure: a prospective observational study

Background Healthcare contributes substantially to greenhouse gas emissions (GHG), and anaesthesia is recognised as a high-impact sector. Evidence comparing the carbon footprint of anaesthetic techniques remains limited, particularly in Europe. We quantified carbon dioxide equivalent (CO 2 e) emissions from inhalation anaesthesia with low-flow sevoflurane, TIVA and spinal anaesthesia during operative hysteroscopy. Methods We performed a prospective GHG-focused life cycle assessment of consecutive patients undergoing operative hysteroscopy in a French university hospital. For each case, we recorded gases, drugs, medical devices, electricity consumption, and their respective costs. Carbon footprints were calculated by Assistance Publique – Hôpitaux de Paris Carebone® platform and expressed in CO 2 e. Results We included 123 participants: 72 underwent inhalation anaesthesia, 22 underwent TIVA, and 29 underwent spinal anaesthesia. Total carbon emissions differed significantly across techniques: median emissions were 10.8 kgCO 2 e [9.1–12.6] for inhalation anaesthesia, 6.6 kgCO 2 e [6.4–6.9] for TIVA and 5.5 kgCO 2 e [5.3–6.2] for spinal anaesthesia ( P <0.001). Volatile anaesthetics were the main contributors for inhalation anaesthesia, pharmaceuticals for TIVA and single-use devices for spinal anaesthesia. Electricity consumption was similar across groups. Conclusions Spinal anaesthesia demonstrated the lowest carbon footprint. TIVA represented the lowest-carbon option for general anaesthesia techniques, whereas inhalation anaesthesia yielded the highest CO 2 e emissions despite low-flow delivery. These findings highlight the mitigation potential of anaesthetic choice even in low-complexity procedures.