A nationwide approach to reduction in anaesthetic gas use: the Dutch Approach to decarbonising anaesthesia.

Summary

The Dutch Approach operationalizes decarbonization of anesthesia through a bottom-up, evidence-informed national guideline that mandates local protocols prioritizing TIVA when feasible, embedded within quinquennial quality audits. By addressing clinician concerns of safety and autonomy, the model aims to sustainably shift practice away from inhalational agents.

Key Findings

• National, bottom-up self-regulatory model developed via safety studies, drug-use inventory, and clinician interviews.
• Guideline mandates local protocols with core message: ‘TIVA when possible, inhalation when necessary’.
• Integration into quinquennial national quality control audits to ensure implementation and monitoring.

Clinical Implications

Institutions can adopt ‘TIVA when possible’ protocols, align procurement and training, and leverage quality audits to track uptake and safety outcomes, accelerating phase-out of high-impact volatiles.

Limitations

• Policy/report narrative without controlled comparative outcomes at scale yet presented.
• Generalizability may vary in health systems lacking national audit mechanisms.

Future Directions

Quantify emissions, safety, and cost outcomes pre/post implementation; adapt and test the model in diverse health systems and include clinician behavior change metrics.