Table 1 Enforced package of measures to promote green anesthesia at the study center

Desflurane is no longer used

Desflurane is retained only as a reserve agent for patients undergoing prenatal myelomeningocele repair surgery.

Nitrous oxide, N₂O, is no longer used

-

TIVA^* with propofol is the standard method of anesthesia unless medically indicated differently

• 1% propofol for procedures < 1 h;

• 2% for procedures > 60 min.

The indications for inhalational anesthesia are limited

• Polytoxicomania;

• Opioid tolerance (e.g. long-term ICU^** patients, chronic pain patients);

• Severe sepsis and burns with high volume of distribution;

• Severe bronchial obstruction;

• Cardiac ischemia;

• Adults with needle phobia for awake inhalation induction;

• Propofol intolerance;

• Fetal surgical procedures;

• Ophthalmologic procedures;

• Pediatric anesthesia.

Unnecessarily high intraoperative FiO2^*** values should be avoided

Respirator settings after intubation: FiO2^*** ≤0.4, aiming to maintain normoxia (SpO2^**** ≥94%).

Unnecessarily high fresh gas flow should be avoided

Usually with ≤ 1 L/min after reaching the

steady state.