Are high fresh gas flow rates necessary during the wash‐in period in low‐flow anesthesia?

Arslan, Mahmut; Gişi, Gökçe; Öksüz, Gözen; Öksüz, Hafize; Bilal, Bora; Boran, Ömer Faruk; Çalışır, Feyza

doi:10.1002/kjm2.12251

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…Low-flow anaesthesia has been found to consume less inhaled anaesthetic, reduce cost, and waste and environmental impact, with improved patient safety compared with using high FGF. 27 The principle of this revolves around a lower FGF equating to higher fractions of gases recirculated within a system, leading to less wastage. Ryan and Nielsen 16 propose achieving ideal FGF rates at 2 L/min with sevoflurane, and 0.5 L/min with desflurane.…”

Section: Discussionmentioning

confidence: 99%

Greenhouse gas reduction in anaesthesia practice: a departmental environmental strategy

et al. 2022

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Sustainability interventions were implemented at the Royal Brisbane and Women’s Hospital (RBWH) following identification of inhaled anaesthetic gases as a target for reducing medical carbon emissions. This quality improvement study assessed and evaluated the impact of sustainability interventions on the environmental and financial cost of inhaled anaesthetic gas use in order to guide future initiatives and research in reducing carbon emissions from healthcare practice.Ethical exemption was granted from the RBWH Research Ethics Committee (EX/2021/QRBW/76078). Usage (bottles) and expenditure for desflurane and sevoflurane from January 2016 to December 2021 were obtained. Global warming potential and carbon dioxide equivalent (CO2e) were used to report environmental impact of volatile agents. Methods to estimate this were performed in Excel based on Campbell and Pierce methodology. An Environmental Protection Agency greenhouse gas equivalency calculator was used to convert CO2e to equivalent petrol carbon emissions and kilometres travelled by a typical passenger vehicle.The total number of bottles of sevoflurane and desflurane purchased between January 2016 and December 2021 decreased by 34.76% from 1991 to 1299. The number of desflurane bottles purchased decreased by 95.63% from 800 to 35 bottles. The number of sevoflurane bottles purchased increased by 6.13% from 1191 bottles to 1264 bottles. This was achieved by implementing quality improvement interventions such as staff education of desflurane-sparing practices, distribution of posters and progressive removal of desflurane from operating theatres. Total carbon emission from volatile anaesthetics equalled 2326 tonnes CO2e. Combined desflurane and sevoflurane emissions decreased by 87.88%. In 2016, desflurane made up 92.39% of the annual CO2e, which steadily decreased to 33.36% in 2021. Combined sevoflurane and desflurane usage costs decreased by 58.33%.Substantial reductions in carbon emissions from volatile anaesthetics demonstrate the significant degree to which environmentally sustainable practices have been implemented. Applying desflurane-sparing practice can heavily limit anaesthetic drug expenditure and contribution to environmental waste. This is important given the global health sector’s challenge to optimise patient outcomes in the face of global climate change crisis.

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Section: Discussionmentioning

confidence: 99%

Greenhouse gas reduction in anaesthesia practice: a departmental environmental strategy

et al. 2022

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“…Throughout the surgery, the vaporizer was adjusted to maintain 0.6 to 0.8 minimum alveolar concentration (MAC). They concluded, that the efficiency of anesthesia in both the first hour and in total was higher in group 1 (P < 0.001) and it is safe, more efficient and economical to use 1 L/min FGF during the wash-in period in LFA [ 18 ]. We hypothesized, that fixed minimal fresh gas flow (0.5L/min) composed with medical air and oxygen (FiO 2 0.8) might decrease oxygen concentration in inhaled mixture more intensively compared with a pure oxygen as a carrier gas.…”

Section: Introductionmentioning

confidence: 99%

Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail

Begashvili,

Kiladze,

Ejibishvili

et al. 2023

Heliyon

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“…Abundant evidence shows that a low fresh gas flow (FGF) during general anesthesia provides better protection than does a high FGF rate in terms of maintaining the heat and humidity of the respiratory system and minimizing the effects of body heat loss. Thus, the body temperature is higher during low-flow anesthesia than during high-flow anesthesia [ 14 – 17 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Hormonal Status in Women on Intraoperative Hypothermia during Laparoscopic Gynecologic Surgery when Considering the Fresh Gas Flow Rate: A Retrospective Study

Lee

et al. 2022

BioMed Research International

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Previous studies reported the impact of intrinsic and extrinsic factors on intraoperative hypothermia. However, no clinical study to date has considered the effects of both the phase of the menstrual cycle (an intrinsic factor) and the fresh gas flow rate (FGF) during anesthesia (an extrinsic factor) on the core body temperature and intraoperative hypothermia. This study is aimed at investigatig the effect of the menstrual cycle phase on intraoperative hypothermia when considering the FGF in patients who underwent laparoscopic gynecologic surgery. This study included 667 women aged 19-65 years with menstruation cycles and menopause. The patients were divided into the follicular, luteal, and menopause groups. The primary outcome was the correlations of hormonal status with intraoperative hypothermia. Secondary outcomes included the incidence of intraoperative hypothermia, time to onset of hypothermia, incidence of shivering after anesthesia, and frequency of antishivering drug use in the three groups and risk factors for hypothermia. Overall, the hypothermia incidence was the lowest and the time to onset of hypothermia was the longest in the luteal phase group. At a high FGF, the incidence of hypothermia in the luteal phase group was lower than that in the other two groups ( P < 0.05 ). At a low FGF, the time to onset of hypothermia in the luteal phase group was longer than that in the other two groups ( P < 0.05 ). The female hormonal status had weak positive correlations with hypothermia at low and high FGF rates. A high FGF in univariate and multivariate analyses, follicular phase and menopause in multivariate analysis, and estradiol and progesterone levels in univariate analysis were risk factors for hypothermia. When considering the FGF, the luteal phase is associated with better outcomes concerning intraoperative hypothermia.

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Are high fresh gas flow rates necessary during the wash‐in period in low‐flow anesthesia?

Cited by 8 publications

References 17 publications

Greenhouse gas reduction in anaesthesia practice: a departmental environmental strategy

Greenhouse gas reduction in anaesthesia practice: a departmental environmental strategy

Minimal fixed flow anesthesia for off-pump coronary artery bypass surgery: A parallel randomized trail

Impact of the Hormonal Status in Women on Intraoperative Hypothermia during Laparoscopic Gynecologic Surgery when Considering the Fresh Gas Flow Rate: A Retrospective Study

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