Economic and Environmental Considerations During Low Fresh Gas Flow Volatile Agent Administration After Change to a...

Area of Science:

• Anesthesiology
• Environmental Health
• Health Economics

Background:

• Reducing fresh gas flow (FGF) in anesthesia lowers costs and environmental impact.
• Legacy carbon dioxide absorbents can produce toxic Compound A, necessitating sevoflurane FGF restrictions.
• Newer nonreactive absorbents eliminate Compound A formation, making previous restrictions obsolete.

Purpose of the Study:

• To evaluate the impact of switching to a nonreactive absorbent on sevoflurane FGF, consumption, cost, and waste.
• To test hypotheses regarding reduced intraoperative FGF, decreased sevoflurane consumption per minute, cost-effectiveness, and minimal residual anesthetic waste.

Main Methods:

• Data on FGF, volatile agent concentrations, and consumption were extracted from an anesthesia information management system.
• Anesthesia providers received notifications and personalized feedback to encourage reduced FGF.
• Batch means were used to compare FGF, consumption, cost savings, and residual sevoflurane before and after absorbent conversion.

Main Results:

• Intraoperative FGF for sevoflurane cases decreased by 435 mL/min (P < 10).
• Sevoflurane consumption per minute decreased by 0.039 mL/min (P < 10).
• Residual sevoflurane in discarded bottles averaged 0.67 mL (P < 10 vs. 2.5 mL).

Conclusions:

• Transitioning to nonreactive carbon dioxide absorbents allows for reduced FGF below recommended limits, proving cost-neutral.
• Electronic monitoring of PICO2 and personalized feedback facilitated the successful reduction in FGF and anesthetic consumption.
• This approach enhances environmental sustainability by reducing volatile anesthetic use and waste.