Environmental and economic impact of using increased fresh gas flow to reduce carbon dioxide absorbent consumption in the absence of inhalational anaesthetics

Fresh gas flow during total intravenous anaesthesia and marginal gains in sustainable healthcare. Comment on Br J Anaesth 2020; 125: 773-8

“…This appears to be because the reduced use of CO2 absorbent canisters is offset by the production of greater volumes of gases. 2,3 However as we have previously noted, there is a marked difference in the carbon intensity of electricity generation in different countries. 7 In Australia (where Zhong and colleagues' study was conducted) electricity generation is predominantly coal-fired and is amongst the most carbonintensive in the world, emitting 0.9 kg CO2e per kWh of electricity.…”

“…1 With this in mind we enjoyed reading Zhong and colleagues' paper on the environmental and financial impacts of different fresh gas flow (FGF) rates during non-volatile anaesthesia. 2 Drawing on their work, we audited the FGF rates when using total intravenous anaesthesia (TIVA) at our institution, a large UK teaching hospital in which TIVA is the technique used in approximately two-thirds of general anaesthetics (internal data). In this letter, we present the results of our audit and consider whether higher FGF rates may have a lower environmental impact than Zhong and colleagues suggest in countries with lower-carbon electricity generation.…”

Rationing oxygen use during total intravenous anaesthesia: a proportionate response?

“…Editor -We read with interest Hall and Chakladar's comment 1 on Zhong and colleague's recent study 2 of the environmental and economic impacts of fresh gas flow (FGF) during total intravenous anaesthesia. Their concern about oxygen use during the coronavirus disease 2019 (COVID-19) pandemic sadly remains topical, as the disease continues to overwhelm critical care capacity in many hospitals.…”

“…Editor—We read with interest Hall and Chakladar's 1 comment on the recent study by Zhong and colleagues 2 of the environmental and economic impacts of fresh gas flow (FGF) during total i.v. anaesthesia.…”

Fresh gas flows, filters, heat and moisture exchangers, and humidification. Comment on Br J Anaesth 2020; 125: 773–778

“…Editor -Zhong and colleagues 1 reported an economic and environmental cost-analysis of differing fresh gas flow (FGF) settings during total intravenous anaesthesia. This study raises an interesting and important point regarding the relationship between the FGF, heat and moisture exchangers (HMEs), and the degree of circuit humidification.…”