Observational audit of sevoflurane consumption during paediatric anaesthesia

Abstract

There is a recognition of the contribution to global warming from emissions of anaesthetic gases into the atmosphere. We audited sevoflurane use to help guide future initiatives to reduce consumption. We observed sevoflurane use during paediatric anaesthesia in a single operating theatre over eight weeks. We recorded demographics, timing of induction and maintenance of anaesthesia, type of circuit used and amount of liquid sevoflurane used (in mL). Ninety-four cases were available for analysis. Of these, 65 had gas inductions and 29 had intravenous (IV) inductions. The median sevoflurane use was 19 mL (interquartile range, IQR 13–24 mL). The median duration of cases was 50.5 min (IQR 35–78 min). The median sevoflurane consumption for cases with a gas induction was 22 mL (IQR 16–26 mL) and for those with an IV induction was 11 mL (IQR 7–17 mL; P < 0.00001). The duration of cases for the gas and IV induction cohorts were similar. During maintenance of anaesthesia, there was no difference between the IV and gas induction cohorts. There was little difference in sevoflurane use between the T-piece and circle system groups. Cases performed with gas inductions consumed twice the sevoflurane as those with IV inductions. Future interventions to reduce sevoflurane consumption should focus on this period.

Restoration Algorithm-Based Ultrasound Image in Evaluating the Effect of Dexmedetomidine on Patients with Neurological Disorder Anesthetized by Sevoflurane

“…Additionally, it induces anesthesia quickly and the patient will recover consciousness in short time. Hence, it is suitable for surgery [ 1 , 2 ]. However, such nontracheal general anesthesia drugs also have disadvantages; that is, there may be transient neurological disorder during the postoperative recovery period [ 3 , 4 ].…”

An audit of inhalational anaesthetic agent usage in paediatric anaesthesia

“…We have previously shown that paediatric anaesthesia uses a disproportionate amount of sevoflurane in our hospital, compared with adult anaesthesia [3]. This is mostly due to high flows used during inhalational induction of anaesthesia, accounting for more than half of the total sevoflurane used in these cases.…”

Time to stop the go slow on the low flow

“…Our data suggest that for children having a gas induction, the induction phase accounts for more than 50% of the total sevoflurane use. 4 Even in adults, using i.v. induction, the initial phase of volatile-based anesthesia can use more than 30% of the total amounts of agent for the case.…”

“…Only 36 of the 220 cases had AGC activated for greater than 20% of the anesthesia time. To compare this with data from our hospital, a recent audit of 94 pediatric cases with a median duration of 50.5 minutes used a median 19 mLs liquid sevoflurane 4. That is, for cases with a similar duration we use approximately half of the sevoflurane.…”