<![CDATA[Volatile anaesthetics contribute to greenhouse gas emissions and health care costs. Low-flow anaesthesia (LFA; fresh gas flow ?1 L/min) may reduce agent consumption, but safety data in routine surgical populations, particularly in LMICs, remain limited. Objective: To compare intraoperative physiological parameters and sevoflurane consumption between LFA and medium-flow anaesthesia (MFA). Methods: In a prospective quasi-experimental study at Zainoel Abidin Regional General Hospital, Indonesia (2025), 60 ASA I-II adults undergoing elective surgery received LFA (n = 30) or MFA (n = 30; 2–4 L/min). SpO2, EtCO2, core temperature, haemodynamics, and sevoflurane consumption were measured during maintenance anaesthesia. Results: No significant differences were observed in SpO2, EtCO2, core temperature, or haemodynamic parameters (all p > 0.05). Sevoflurane consumption was significantly lower with LFA (4.02 ± 1.07 vs. 8.92 ± 1.83 mL/h), representing a 55% reduction. This remained significant after ANCOVA adjustment (adjusted mean difference-4.73 mL/h, 95% CI-6.08 to-3.38;p < 0.001) and multivariable regression (? = ?4.61, 95% CI-5.82 to-3.40; p < 0.001). Conclusion: LFA substantially reduces sevoflurane use without compromising oxygenation, ventilation, thermoregulation, or haemodynamic stability, supporting its safe, cost-effective, and environmentally responsible use in selected low-risk patients.]]>
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