The Dutch anaesthesiologist reducing health emissions, one surgery at a time
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Dr. Niek Sperna Weiland initially wanted to be a journalist, but his insatiable curiosity and desire to make a difference led him to anaesthesiology - and ultimately - to leading a quiet revolution in healthcare.
In the Netherlands, anaesthesiologists have reduced their use of anaesthetic gases by an astonishing 61% over just a few years, drastically reducing greenhouse gas emissions from the Dutch health sector. At the heart of this change is Dr. Niek Sperna Weiland, a 38-year-old anaesthesiologist from Amsterdam University Medical Centre (also known as Amsterdam UMC) who has helped develop what's known as the "Dutch Approach" - a model that could reshape how healthcare tackles its environmental footprint.
A "Goldilocks" problem
"We call it the Goldilocks scenario," says Dr. Sperna Weiland, referring to replacing anaesthetic gases, used to keep patients unconscious during surgery, with intravenous (IV) anaesthetics. It is an action that is “just right,” as it reduces energy consumption, emissions, costs, and nausea in patients after surgery – leading to shorter hospital stays in many cases.
"It's a huge climate impact, it's better for patients, and it costs less."
Anaesthetic gases account for roughly 3% of the entire healthcare sector's carbon output - and up to 63% of emissions from surgical care alone in high-resource settings.
"If we would avoid only desflurane, which is completely clinically not necessary, then we could overnight reduce the impact of the whole country of Denmark," Dr. Sperna Weiland explains.
But the problem extends beyond climate. Anaesthetic gases are also per- and polyfluoroalkyl substances (PFAS) - also known as "forever chemicals" - that accumulate in the environment and in the body. A recent study in Switzerland found that almost 6.5% of all PFAS in the environment come from anaesthetic gases (table 2).
His first step into sustainability
In 2016, at the end of his residency, Dr. Sperna Weiland attended a presentation by Dr Kate Huncke, from the USA, on sustainability which made him think of the materials thrown away in the operating room. "I was just blown away," he recalls, "I was very worried about environmental pollution and climate change. Every summer gets warmer, and there's these extremes. But I was struggling to find an appropriate avenue for action. There's only so much you can do as a private person."
His philosophy crystallized, he saw a need and saw a way to make a difference. “You can make a much bigger impact if you can transform the company you work for.” At the end of his residency in 2018, he gave a presentation to his entire department about the environmental impact of anaesthesia. The response to this new idea was overwhelming, "Everybody was very supportive," he said. "They said, 'Wow, this is something we've never heard before. We should do something with this.'" That support led to the founding of the first "Green Team" in the Netherlands, focusing on three areas: anaesthetic gases, energy use, and materials.
The Dutch Approach: bottom-up change
Rather than imposing top-down regulations, methods were built from the ground up. The team conducted systematic reviews of patient safety data, surveyed over 77 anaesthesia practices, and interviewed anaesthesiologists to understand their concerns. Patient safety and health outcomes are paramount when changing clinical systems. A systematic review and meta-analysis of 317 randomized controlled trials and 51 107 patients concluded that patient safety is not affected by omitting anaesthetic gases.
The result was a national guideline with a simple message: "Total Intravenous Anaesthesia (TIVA) when possible, inhalation anaesthesia when necessary." Instead of banning gases, the approach empowers individual departments to develop their own protocols. Between 2019 and 2022, Dutch anaesthesiologists reduced their carbon footprint from anaesthetic gases by 61% (9.97 kt in 2019 to 3.87 kt in 2022) while increasing the use of intravenous alternatives.
The China connection
Dr. Sperna Weiland's curiosity didn't stop at the Dutch border. Through a government-to-government Global Health Partnerships Programme, he became involved in the Sino-Dutch Green Hospital Partnership, a collaboration between the Netherlands and China. The Netherlands has about 2 500 anaesthesiologists; China has 105 000. The Netherlands has 69 hospitals providing anaesthesia; China has 11 500. "When it goes to scale, we actually make a difference," Dr. Sperna Weiland notes.
When the partnership began, a survey found that 97% of Chinese anaesthesiologists were unaware of the environmental impact of their practice. The collaboration started with translating materials into Chinese, working with designers to make them culturally relevant, and gaining support from influential health leaders in China. There are now programs for Chinese anaesthesiologists to visit Amsterdam for internships to take Dutch practices back to Chinese hospitals.
Local action geared for global change
As chair of the sustainability committee at the European Society of Anaesthesiology and Intensive Care, Dr. Sperna Weiland is helping implement the Dutch Approach in 44 countries across the continent. But challenges remain: behavioural change is difficult, equipment investments may be needed, and supply chain vulnerabilities emerged during COVID-19. There are also challenges posed by pushback from companies making money on the gas-based approach.
Success gives rise to action, "In the Netherlands, we can be a playground with a very high-achieving healthcare system and try out different things, showing it can be done sustainably without loss of quality and maybe even cheaper. Then export that way of working to other countries that can just copy-paste it and don't have to pay for the whole innovation."
For Dr. Sperna Weiland, the journey from would-be journalist to climate-conscious anaesthesiologist has come full circle. His curiosity about how things work has led him behind the scenes - not to writestories, but to change them.
What's Next:
The Sino-Dutch Green Hospital Partnership has entered its second phase (2026-2027), focusing on scaling best practices in green anaesthesia, green ICUs, green procurement, and remote learning for health workers.
Building off such powerful bilateral relationships, ATACH aims to leverage its global platform for even wider reach, launching a Country Partnership Programme which looks to pair small groups of two to three Member Countries together for sustained collaboration over a two-year period. Beginning as a pilot programme, this work will expand over time to include more ATACH country members as capacity grows, and participants will be supported to develop and publish practical case studies to share their learning with the wider ATACH community.