Inhaled anesthetics represent significant drug costs for anesthesia care, and previously, there have been limited or unreliable ways to measure the efficient use of anesthetics. In addition, the negative environmental impact of volatile anesthetics is a growing concern, so there is an increased focus on responsibly delivering an anesthetic. Low-flow anesthesia has gained popularity due to recent advances in anesthesia machines and CO 2 absorbents, which allow anesthesiologists to use low-flow anesthesia and develop an environmentally and financially conscious practice more easily than before. This quality improvement initiative was designed focusing on the efficient use of sevoflurane to limit the costs incurred from sevoflurane overuse and translate this improvement to carbon footprint equivalents of miles driven by an average car, gallons of gasoline, and pounds of coal burned.

Performing a preuse self-test on a nonexpanded pediatric circuit that is then expanded leads to falsely elevated displayed tidal volume in infants less than 10 kg during pressure-controlled ventilation. Overestimation of reported tidal volume can be avoided by expanding the breathing circuit tubing to the length which will be used during a case prior to performing the anesthesia machine preuse self-test. After department-wide education and implementation, performing a correct preuse self-test is now the standard practice in our cardiac operating rooms.

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Background: Due to excess catheter length, pediatric patients undergoing cardiac surgery frequently have the tip of the central venous catheter trimmed while on bypass to obtain optimal catheter positioning. Aims:We sought to determine if there is a correlation between the patient's height or weight and the length of catheter removed. Our secondary aim compared the instances of central line-associated bloodstream infections and venous thromboembolisms between the trimmed and untrimmed catheters.Methods: This retrospective study included patients having undergone cardiac surgery over a 3-year period who had an 8 cm central venous catheter placed in the right internal jugular vein. Hospital lists of central line-associated bloodstream infections and venous thromboembolisms that occurred were cross referenced with our study patients.Results: There were 147 cases where the 8 cm central venous catheter was trimmed, which represents 35% of the cases. Of the catheters that were cut, on average 2.17 cm was removed.There is negligible correlation between the length of catheter removed and patient height (r = −.19, p = .021). There is negligible correlation between the length of catheter removed and patient weight (r = −.17, p = .039).There were no instances of central line-associated bloodstream infections or venous thromboembolisms attributed to the trimmed catheters. Of the 273 untrimmed catheters, there were no instances of an infection and one instance of a venous thromboembolism. Conclusion:Right internal jugular 8 cm central venous catheters are trimmed during pediatric cardiac surgery, and there is minimal correlation between the length removed and the patient height or weight. Due to the difficulty in estimating the proper length of a central venous catheter in smaller pediatric patients, placing an 8 cm long catheter in these patients and then trimming the distal tip while on bypass may be the most accurate way to properly position a catheter.