Economic and Environmental Considerations During Low Fresh Gas Flow Volatile Agent Administration After Change to a Nonreactive Carbon Dioxide Absorbent

Abstract

We showed that an anesthesia department can transition to a premium, nonreactive carbon dioxide absorbent in a manner that is at least cost neutral by reducing FGF below the lower flow limits recommended in the sevoflurane package insert. This was achieved, in part, by electronically monitoring PICO2, automatically notifying the anesthesia technicians when to change the absorbent, and by providing personalized feedback via e-mail to the anesthesia providers.

The effect of fresh gas flow during induction of anaesthesia on sevoflurane usage: a quality improvement study

“…These techniques have been shown to produce similar results , and can be reported as a volume of liquid or as cost . Our work and that of others has used the mean FGF for a case as the marker of gas and agent consumption. Although we initially used this as a pragmatic approach to facilitate data collection over a large number of cases, we consider mean FGF a useful index of consumption since FGF is what the user sees and controls and, as discussed above, is a major driver of volatile consumption.…”

“…. Although this concept may seem obvious, the impact of FGF in the early phase of anaesthesia on vapour use has not previously been explored in detail, and is frequently explicitly excluded from studies of FGF and vapour utilisation that focus on FGF in the maintenance phase . Our data suggest that this early ‘induction’ phase can have an important effect on total agent consumption at both low and moderate maintenance FGF, and is modifiable.…”

“…GE Aisys were introduced in early 2011. Data from the study described in this paper are labelled 16/17 A, 16/17 B and 16/17 C. Also included are data from a number of studies of fresh gas flow ( FGF ) which have described their results as average FGF . The data from all these other studies are for flows during the maintenance period only.…”

“…). Although this approach appears intuitive, many important studies of FGF and agent consumption exclude the initial phase of anaesthesia, commencing data collection after induction or when surgery starts .…”

“…Vapour consumption is measured in several ways, including direct measures such as weighing vaporisers or recording data from machine logs . These techniques have been shown to produce similar results , and can be reported as a volume of liquid or as cost . Our work and that of others has used the mean FGF for a case as the marker of gas and agent consumption.…”