BACKGROUND Anaesthetic gases are an important source of greenhouse gas emissions from operating theatres and can attribute significantly to the carbon footprint of a nation's healthcare system. OBJECTIVE To estimate the magnitude of the climate impact of inhaled anaesthetics in the Netherlands. Furthermore, the goal was to assess the preferences of Dutch anaesthesiologists for anaesthesia techniques, and to explore opportunities for reducing greenhouse gas emissions due to anaesthesia practice. DESIGN A 2019 bottom-up purchase analysis of inhalation anaesthetics used in all of the Dutch hospitals was executed and an online survey was conducted among Dutch anaesthesiologists regarding their preferences for anaesthetic agents. RESULTS Purchasing quantities of volatile anaesthetic agents were obtained from 61 of the 69 hospital organisations in the Netherlands (response rate 88.4%). A total of 12.2 kilotons CO2 equivalent (0.07% of the Dutch healthcare system) was emitted due to inhalation anaesthetics in the Netherlands in 2019. The volume of the in 2019 purchased inhalation volatile anaesthetics was 9.178 l of sevoflurane (93.4%), 404 l of desflurane (4.1%) and 245 l of isoflurane (2.5%). The survey in which 182 anaesthesiologists participated demonstrated that propofol was the first drug of choice of 70% of respondents, desflurane was available in 16% of Dutch hospitals and 83% of anaesthesiologists answered never using desflurane. Nitrous oxide was not used by 63% of respondents, the remaining 27% reported using nitrous oxide only in less than 5% of their cases. CONCLUSION The relatively low emission of greenhouse gases due to inhalation anaesthetics in Dutch healthcare compared to other countries can be explained by the limited use of nitrous oxide and desflurane by Dutch anaesthesiologists and their strong preference for intravenously administered propofol as an anaesthetic.