Abstract
Anaesthetic gases account for ∼3% of the carbon footprint of the entire healthcare sector and up to 63% of the emissions originating from surgical care. Transitioning to predominant use of total intravenous anaesthesia (TIVA) has been proven a safe and effective strategy to reduce this footprint, yet its adoption has been slow in most countries. Interventions at the national level have been limited to regulatory action (e.g. banning of desflurane) and publication of nonbinding recommendations and best practices. We describe a new approach that we used to drive sustainable change and apply it to the debate between TIVA and inhalation anaesthesia at the national level. The Dutch Approach is founded on a bottom-up, self-regulatory model grounded in evidence-based practices. Patient safety studies, a national inventory of anaesthetic drug use, and in-depth interviews with anaesthetists were combined in developing a national guideline. Meeting the two main concerns among anaesthetists, patient safety and professional autonomy, the guideline requires all Dutch anaesthetic practices to adopt a local protocol whose main message is 'TIVA when possible, inhalation anaesthesia when necessary'. Central to the approach was the integration within the national quinquennial quality control audits. Adoption and implementation will be monitored and evaluated in an ongoing research project.