Reducing Volatile Anesthetic Waste Using a Commercial Electronic Health Record Clinical Decision Support Tool to Lower Fresh Gas Flows

Olmos, Andrea V; Robinowitz, David L; Feiner, John; Chen, Catherine L.; Gandhi, Saurabh

doi:10.1213/ane.0000000000006242

Cited by 11 publications

(3 citation statements)

References 34 publications

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“…Interventions targeting at reducing the consumption of volatile anesthetics carry a much higher potential for reduction of GHG emissions: A recent study calculated a potential of a reduction of 1.8 kg CO 2 -equivalent (global warming potential 20 years, GWP 20 ) due to saving of sevoflurane during a 45min case if modern anesthesia workstations were used most efficiently [ 9 ]. A clinical decision support tool aiding anesthesiologists to use volatile anesthetics more efficiently led to a saving of 4.1 ml desflurane or 3.8 ml per MAC‑h sevoflurane [ 22 ]. Depending on the estimation of the relative GWP of volatile anesthetics, this amounts to a reduction in CO 2 -equivalent (GWP 20 ) of 22 kg to 41 kg for desflurane and 2.0 kg to 4.6 kg for sevoflurane [ 23 – 26 ].…”

Section: Discussionmentioning

confidence: 99%

Electricity consumption of anesthesia workstations and potential emission savings by avoiding standby

Drinhaus,

Schumacher

et al. 2024

Anaesthesiologie

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Background Anesthesiology has a relevant carbon footprint, mainly due to volatile anesthetics (scope 1 emissions). Additionally, energy used in the operating theater (scope 2 emissions) contributes to anesthesia-related greenhouse gas (GHG) emissions. Objectives Optimizing the electricity use of medical devices might reduce both GHG emissions and costs might hold potential to reduce anaesthesia-related GHG-emissions and costs. We analyzed the electricity consumption of six different anesthesia workstations, calculated their GHG emissions and electricity costs and investigated the potential to reduce emissions and cost by using the devices in a more efficient way. Methods Power consumption (active power in watt , W) was measured with the devices off, in standby mode, or fully on with the measuring instrument SecuLife ST. Devices studied were: Dräger Primus, Löwenstein Medical LeonPlus, Getinge Flow C, Getinge Flow E, GE Carestation 750 and GE Aisys. Calculations of GHG emissions were made with different emission factors, ranging from very low (0.09 kg CO2-equivalent/kWh) to very high (0.660 kg CO2-equivalent/kWh). Calculations of electricity cost were made assuming a price of 0.25 € per kWh. Results Power consumption during operation varied from 58 W (GE CareStation 750) to 136 W (Dräger Primus). In standby, the devices consumed between 88% and 93% of the electricity needed during use. The annual electricity consumption to run 96 devices in a large clinical department ranges between 45 and 105 Megawatt-hours (MWh) when the devices are left in standby during off hours. If 80% of the devices are switched off during off hours, between 20 and 46 MWh can be saved per year in a single institution. At the average emission factor of our hospital, this electricity saving corresponds to a reduction of GHG emissions between 8.5 and 19.8 tons CO2-equivalent. At the assumed prices, a cost reduction between 5000 € and 11,600 € could be achieved by this intervention. Conclusion The power consumption varies considerably between the different types of anesthesia workstations. All devices exhibit a high electricity consumption in standby mode. Avoiding standby mode during off hours can save energy and thus GHG emissions and cost. The reductions in GHG emissions and electricity cost that can be achieved with this intervention in a large anesthesiology department are modest. Compared with GHG emissions generated by volatile anesthetics, particularly desflurane, optimization of electricity consumption of anesthesia workstations holds a much smaller potential to reduce the carbon footprint of anesthesia; however, as switching off anesthesia workstations overnight is relatively effortless, this behavioral change should be encouraged from both an ecological and economical point of view.

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Section: Discussionmentioning

confidence: 99%

Electricity consumption of anesthesia workstations and potential emission savings by avoiding standby

Drinhaus,

Schumacher

et al. 2024

Anaesthesiologie

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“…Our results predict that an entirely effective volatile anesthetic gas capture system can have considerable environmental and economic value even when applied along with a departmental low-flow program. [11][12][13][14] Reducing fresh gas flows is critical but does not mitigate the environmental need to prevent airborne release of the scavenged agent. That is especially true when desflurane is used because each milliliter has several-fold greater global warming potentials than the same liquid volume as sevoflurane.…”

Section: Discussionmentioning

confidence: 99%

Associations Between Fresh Gas Flow and Duration of Anesthetic on the Maximum Potential Benefit of Anesthetic Gas Capture in Operating Rooms and in Postanesthesia Care Units to Capture Waste Anesthetic Gas

Dexter,

Epstein

2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Sevoflurane and desflurane are halogenated hydrocarbons with global warming potential. We examined the maximum potential benefit assuming 100% efficiency of waste gas capture technology used in operating rooms and recovery locations. METHODS: We performed computer simulations of adult patients using the default settings of the Gas Man software program, including the desflurane vaporizer setting of 9% and the sevoflurane vaporizer setting of 3.7%. We performed 21 simulations with desflurane and 21 simulations with sevoflurane, the count of 21 = 1 simulation with 0-hour maintenance + (1, 2, 3, 4, or 5 hours of maintenance) × (0.5, 1, 2, or 4 L per minute fresh gas flow during maintenance). RESULTS: (1) A completely efficient gas capture system could recover a substantive amount of agent even when the case is managed with low flows. All simulations had at least 22 mL agent recovered per case, considerably greater than the 12 mL that we considered the minimum volume of economic and environmental importance. (2) All 42 simulations had at least 73% recovery of the total agent administered, considerably greater than the median 52% recovery measured during an experimental study with one gas capture technology and desflurane. (3) The maximum percentage desflurane (or sevoflurane) that could be captured decreased substantively with progressively longer duration anesthetics for low-flow anesthetics but not for higher-flow anesthetics. However, for all 8 combinations of drug and liters per minute simulated, there was a substantively greater recovery in milliliters of agent for longer duration anesthetics. In other words, if gas capture could be near perfectly efficient, it would have greater utility per case for longer duration anesthetics. (4) Even using a 100% efficient gas capture process, at most 6 mL liquid desflurane or 3 mL sevoflurane per case would be exhaled during the patient’s stay in the postanesthesia care unit. Therefore, the volume of agent exhaled during the first 1 hour postoperatively is not a substantial amount from an environmental and economic perspective to warrant consideration of agent capture by having all these patients in the postanesthesia care unit, or equivalent locations, using the specialized anesthetic gas scavenging masks with access to the hospital scavenging system at each bed. CONCLUSIONS: Simulations with Gas Man show a strong rationale based on agent uptake and distribution for using volatile anesthetic agent capture in operating rooms if the technology can be highly efficient at volatile agent recovery.

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“…For example, individual hospital systems, such as University of California–San Francisco (UCSF) hospitals and Yale University Hospital, are utilizing electronic health records to change the type of and reduce the flow rate of anesthetic gases. 33 , 34 On the national level, Practice GreenHealth (a nonprofit collaborative focused on developing environmentally conscious solutions for healthcare) facilitates multiorganizational collaborations in running pilots and scaling efforts. 38 Additionally, many case examples also document clear financial incentives and outcomes (such as the cost savings cited by CommonSpirit and Kaiser).…”

Section: Key Themes To Implement Decarbonization Practicesmentioning

confidence: 99%

A race to net zero—early lessons from healthcare's decarbonization marathon

Lakatos

Thottathil²,

Gandhi

et al. 2023

Health Affairs Scholar

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Climate change poses a threat to healthcare systems; at the same time, healthcare systems contribute to a worsening climate. Climate-induced disasters are predicted to increase both the demand for healthcare services while also posing a threat to the integrity of healthcare systems' infrastructures and supply chains. Many healthcare organizations have taken initiatives to prepare for such disasters through implementing carbon emission–reduction practices and infrastructure reinforcement, through globally recognized frameworks and strategies known as Scopes 1, 2, and 3, and decarbonization. We explored the efforts of these early adopters to understand how they are thinking about and addressing climate change's impacts on healthcare. Through a process of reviewing the peer-reviewed literature, publicly available published documents, annual sustainability reports, conference presentations, and participation in a national decarbonization collaborative, we (1) provide a diverse set of examples showcasing the variety of ways healthcare systems are responding; (2) identify a set of emergent key themes to implementing decarbonization practices, such as the role of an organizational culture of iterative improvement and building systems of cross-organizational collaboration; and (3) synthesize the identifiable set of driving factors for long-term sustainability of these decarbonization efforts.

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Reducing Volatile Anesthetic Waste Using a Commercial Electronic Health Record Clinical Decision Support Tool to Lower Fresh Gas Flows

Cited by 11 publications

References 34 publications

Electricity consumption of anesthesia workstations and potential emission savings by avoiding standby

Electricity consumption of anesthesia workstations and potential emission savings by avoiding standby

Associations Between Fresh Gas Flow and Duration of Anesthetic on the Maximum Potential Benefit of Anesthetic Gas Capture in Operating Rooms and in Postanesthesia Care Units to Capture Waste Anesthetic Gas

A race to net zero—early lessons from healthcare's decarbonization marathon

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