Interventions to reduce desflurane use in hospitals: A systematic review

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.