Interventions to reduce desflurane use in hospitals: A systematic review
4 affiliations
- 1Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- 2Healthy Environments and Lives (HEAL) Global Research Centre, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- 3Concord Hospital, Sydney Local Health District, Concord, NSW, Australia
- 4Musculoskeletal Health and Wiser Health Care Units, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Abstract
Desflurane is a potent greenhouse gas (GHG) and major contributor to healthcare carbon emissions. Clinician-led interventions to reduce its use have been implemented, but their effectiveness has not been systematically reviewed. We aimed to synthesise available evidence on the effectiveness of hospital-based interventions designed to reduce desflurane use. Four databases were searched from inception to 3 July 2025. Randomised and non-randomised controlled trials (RCTs), interrupted time series (ITS) and controlled or uncontrolled before-and-after studies were included. Outcome measures were desflurane consumption (primary), GHG emissions, costs, alternate anaesthetic consumption and staff outcomes. Paired authors independently screened studies, extracted data, assessed risk of bias and certainty of the evidence. Due to heterogeneity, results were synthesised using a structured summary of intervention effects with no meta-analysis. Twenty-three studies were included: 13 uncontrolled before–after studies, seven ITSs and three RCTs. Common interventions were environmental changes (n = 20) and education (n = 19). No study was rated at low risk of bias across all criteria. All studies that reported impacts on desflurane consumption (17/17), GHG emissions (16/16) and costs (14/14) found reductions. Use of alternative anaesthetics was inconsistent for sevoflurane (n = 15) and isoflurane (n = 7) but increased for propofol (n = 7). Staff knowledge (3/4) and behaviour (3/3) improved; however, attitudes were unfavourable (1/1) and acceptability was inconsistent (1/1). The evidence was very uncertain for all outcomes. Hospital-based interventions targeting desflurane use may reduce consumption, GHG emissions and costs, with inconsistent effects on alternative anaesthetic use and staff outcomes. However, the evidence is very uncertain.
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BibTeX
@article{verlis2026interventions,
title = {{Interventions to reduce desflurane use in hospitals: A systematic review}},
author = {Krista M Verlis and Luise Kazda and Alexandra L Barratt and Philomena Colagiuri and Anthony Hull and Romi Haas and Kristen Pickles},
journal = {Anaesthesia and Intensive Care},
year = {2026},
month = oct,
doi = {10.1177/0310057x261484168},
url = {https://doi.org/10.1177/0310057x261484168},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Interventions to reduce desflurane use in hospitals: A systematic review
AU - Krista M Verlis
AU - Luise Kazda
AU - Alexandra L Barratt
AU - Philomena Colagiuri
AU - Anthony Hull
AU - Romi Haas
AU - Kristen Pickles
PY - 2026
DA - 2026/10/09
JO - Anaesthesia and Intensive Care
DO - 10.1177/0310057x261484168
UR - https://doi.org/10.1177/0310057x261484168
AB - Desflurane is a potent greenhouse gas (GHG) and major contributor to healthcare carbon emissions. Clinician-led interventions to reduce its use have been implemented, but their effectiveness has not been systematically reviewed. We aimed to synthesise available evidence on the effectiveness of hospital-based interventions designed to reduce desflurane use. Four databases were searched from inception to 3 July 2025. Randomised and non-randomised controlled trials (RCTs), interrupted time series (ITS) and controlled or uncontrolled before-and-after studies were included. Outcome measures were desflurane consumption (primary), GHG emissions, costs, alternate anaesthetic consumption and staff outcomes. Paired authors independently screened studies, extracted data, assessed risk of bias and certainty of the evidence. Due to heterogeneity, results were synthesised using a structured summary of intervention effects with no meta-analysis. Twenty-three studies were included: 13 uncontrolled before–after studies, seven ITSs and three RCTs. Common interventions were environmental changes (n = 20) and education (n = 19). No study was rated at low risk of bias across all criteria. All studies that reported impacts on desflurane consumption (17/17), GHG emissions (16/16) and costs (14/14) found reductions. Use of alternative anaesthetics was inconsistent for sevoflurane (n = 15) and isoflurane (n = 7) but increased for propofol (n = 7). Staff knowledge (3/4) and behaviour (3/3) improved; however, attitudes were unfavourable (1/1) and acceptability was inconsistent (1/1). The evidence was very uncertain for all outcomes. Hospital-based interventions targeting desflurane use may reduce consumption, GHG emissions and costs, with inconsistent effects on alternative anaesthetic use and staff outcomes. However, the evidence is very uncertain.
SN - 0310-057X
SN - 1448-0271
ER -