Promoting low-flow anaesthesia and volatile anaesthetic agent choice

Abstract

BackgroundAs doctors, we are increasingly aware of the financial implications of our practice. The need to work in a more conscientious, efficacious and cost-effective manner is greater than ever before. Environmental and financial benefits can be seen through employing the use of low-flow anaesthesia.AimsThis quality improvement project aimed to make anaesthetic practice more environmentally friendly and to reduce departmental spending. This could be achieved by promoting the use of low-flow anaesthesia and by encouraging isoflurane use where appropriate.MethodsAll anaesthetic consultants and trainees were invited to fill out an initial questionnaire relating to their personal preferences and practices when conducting anaesthesia. There were specific questions relating to low-flow anaesthesia and isoflurane use. Our main measure of improvement was any decrease in the number of bottles of volatile agent ordered by the department from pharmacy. Monthly spot audits were conducted to assess gas flow rates and volatile agent use in theatre. Departmental spending figures relating to the purchase of volatile agent bottles were obtained from pharmacy. Information was then disseminated to anaesthetists on a monthly basis via a ‘low-flow board’, which showed pictorial and graphical representations of differing gas flows and volatile agent usage in relation to cost.ResultsOur project showed a trend for the increased use of low-flow anaesthesia within the department. We also showed a decrease in the number of bottles of volatile agent ordered: 18% fewer bottles ordered compared with the same period the previous year. This represented a 25% decrease in total departmental expenditure on volatile agents despite an increase in theatre activity.ConclusionIncreasing awareness regarding anaesthetic choices and promoting low-flow anaesthesia and isoflurane use, translated into an overall decreased departmental spend on volatile agents without affecting patient care.

The effect of low flow anesthesia on hemodynamic and peripheral oxygenation parameters in obesity surgery

“…Low-flow anesthesia has been used in many different patient groups and has been found to be similar to or better than high-flow anesthesia in many ways. 12 , 13 …”

“…Low-flow anesthesia has been used in many different patient groups and has been found to be similar to or better than high-flow anesthesia in many ways. 12,13 Table 3 -Arterial blood gas analysis. Obesity surgery has the potential to increase the risks of hypoperfusion, bleeding, hypovolemia, and prolonged surgical procedures.…”

Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: A systematic review

“…Of those studies that aimed to change anaesthetic gas use (Epstein et al 37 , Glenski & Levine 39 , Carter et al 40 , and Zuegge et al 38 ), all four reported a reduction in emissions after the intervention, through for example, increasing uptake of low ow anaesthesia or replacing more potent inhalational anaesthesia with lower emissions alternatives. Epstein et al 37 reported a statistically signi cant reduction in Sevo urane use (P < .001) and a non-signi cant decrease in the number of gas bottles purchased (P = .81), when comparing 8 -week periods before and after their intervention.…”

“…Reporting bias was not well de ned for three studies: Carter et al 40 and Zuegge et al 38 did not adequately de ne the number of participants or the intervention.…”

The Effect of Low- Flow Anesthesia on Hemodynamic Parameters and Gas Consumption in Single Lung Ventilation

“…Low-flow anesthesia is a method which is applied by using a re-inhaled anesthesia system during general anesthesia, where the re-inhaled fresh oxygen flow rate is at least 50%, the metabolic requirement is fully met and sufficient volatile agent can be given [1] . The main advantages of low-flow anesthesia include lowering the cost of inhaled agents by reducing the amount of inhaled agent consumed, providing better dynamics, maintaining airway moisture, reducing atmospheric pollution, maintaining ecological balance and lowering heat loss [2] .…”