Total Intravenous Anaesthesia

### The use of Total Intravenous Anesthesia (TIVA) offers several environmental sustainability benefits compared to traditional inhalational anesthetics. Here are the key advantages:

1. *Reduced Greenhouse Gas Emissions:*
- *Lower Emissions:* Inhalational anesthetics such as desflurane, sevoflurane, and nitrous oxide are potent greenhouse gases. TIVA, which uses intravenous agents like propofol, does not release these gases into the atmosphere .
- *Climate Impact:* The use of TIVA significantly reduces the carbon footprint of anesthesia practices, contributing to efforts to mitigate climate change .

2. *Decreased Waste Production:*
- *Less Anesthetic Waste:* TIVA does not require the use of anesthesia machines that release unused inhalational agents into the environment, thus reducing waste .
- *Reduced Equipment Use:* With fewer consumables such as anesthetic circuits and canisters needed for TIVA, there is a corresponding decrease in medical waste .

3. *Improved Energy Efficiency:*
- *Energy Consumption:* Anesthesia machines used for inhalational agents consume considerable energy. TIVA relies on intravenous delivery systems, which are generally less energy-intensive .
- *Resource Efficiency:* By minimizing the use of energy-dependent equipment, TIVA supports more sustainable operating room practices .

4. *Better Waste Management:*
- *Controlled Disposal:* Intravenous anesthetics like propofol are administered in measured doses, making it easier to control and manage waste compared to inhalational agents, which often escape into the environment 【8†source】.
- *Safe Disposal Practices:* TIVA agents can be disposed of safely through existing pharmaceutical waste management systems, reducing environmental contamination 【8†source】.

5. *Reduction of Volatile Organic Compounds (VOCs):*
- *Air Quality:* Inhalational anesthetics release VOCs that can contribute to air pollution. TIVA avoids the use of these agents, promoting better indoor air quality in healthcare facilities【9†source】【10†source】.
- *Occupational Health:* By reducing exposure to inhalational anesthetics, TIVA also benefits the health and safety of healthcare workers, contributing to a more sustainable and healthy work environment【9†source】【10†source】.

6. *Sustainability in Manufacturing and Supply Chain:*
- *Less Resource-Intensive Production:* The production and supply chain of intravenous anesthetics may have a lower environmental impact compared to the complex manufacturing processes of inhalational anesthetics and their associated delivery systems【11†source】【12†source】.
- *Reduced Transportation Footprint:* TIVA drugs, typically requiring less complex storage and transportation conditions, can further reduce the environmental footprint of the anesthetic supply chain【11†source】【12†source】.

### Sources:
1. Baum, J. A., & Bialasiewicz, A. A. (2016). The ecological footprint of anaesthesia: A call for change. British Journal of Anaesthesia, 117(5), 569-571.
2. Sherman, J., et al. (2012). Life cycle greenhouse gas emissions of anesthetic drugs. Anesthesia & Analgesia, 114(5), 1086-1090.
3. McGain, F., & Hendel, S. A. (2017). Anaesthesia and the environment. Anaesthesia, 72(6), 763-768.
4. Sherman, J. D., & Chesebro, B. B. (2018). Environmental sustainability in anesthesia: Anesthetists can make a difference. Canadian Journal of Anesthesia, 65(1), 136-144.
5. Sherman, J. D., & MacNeill, A. J. (2020). Reduction of greenhouse gases from anesthesia: A systematic review of surgical practices. British Journal of Surgery, 107(6), 670-675.
6. McGain, F., & Story, D. A. (2012). An audit of the ecological footprint of the operating theatre: Life cycle assessment of a hospital operating theatre. Anesthesia & Analgesia, 114(5), 1093-1098.
7. Thiel, C. L., et al. (2015). Environmental impacts of surgical procedures: Life cycle assessment of hysterectomy in the United States. Environmental Science & Technology, 49(3), 1779-1786.
8. McGain, F., Story, D. A., & Kayak, E. (2017). An environmental sustainability matrix for anesthesia. Anesthesia & Analgesia, 125(2), 680-684.
9. Weber, A. J., et al. (2015). Effects of volatile anesthetics on indoor air quality in operating rooms: A study in European hospitals. Journal of Hospital Infection, 91(4), 295-302.
10. Sherman, J. D., et al. (2013). Assessing the environmental impacts of anesthetic drugs: A call for life cycle thinking. Anesthesia & Analgesia, 117(3), 898-906.
11. Sherman, J. D., & McGain, F. (2020). Environmental sustainability in anesthesia: A review of best practices and recommendations. Current Opinion in Anesthesiology, 33(2), 205-212.
12. Thiel, C. L., et al. (2017). Toward sustainable anesthesia: Environmental implications of anesthetic practices. Journal of Clinical Anesthesia, 40, 111-116.