The implementation of low‐flow anesthesia at a tertiary pediatric center: A quality improvement initiative

Abstract

Inhaled anesthetics represent significant drug costs for anesthesia care, and previously, there have been limited or unreliable ways to measure the efficient use of anesthetics. In addition, the negative environmental impact of volatile anesthetics is a growing concern, so there is an increased focus on responsibly delivering an anesthetic. Low-flow anesthesia has gained popularity due to recent advances in anesthesia machines and CO 2 absorbents, which allow anesthesiologists to use low-flow anesthesia and develop an environmentally and financially conscious practice more easily than before. This quality improvement initiative was designed focusing on the efficient use of sevoflurane to limit the costs incurred from sevoflurane overuse and translate this improvement to carbon footprint equivalents of miles driven by an average car, gallons of gasoline, and pounds of coal burned.

Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region

“… Using low fresh gas flow or closed-circuit delivery can reduce the volume of volatile gas consumed by 20%. 45 , 50 , 51 New technologies, such as Dynamic Gas Scavenging Systems or silica zeolite, can absorb, destroy, and even recycle anaesthetic waste gases. 52 , 53 , 54 …”

“…Using low fresh gas flow or closed-circuit delivery can reduce the volume of volatile gas consumed by 20%. 45 , 50 , 51 …”

Sustainable veterinary anaesthesia: single centre audit of oxygen and inhaled anaesthetic consumption and comparisons to a hypothetical model

“…This could have the additional benefit of reducing the financial cost of anaesthesia, although the purchase of new breathing systems and increased use of soda‐lime would need to be included in any calculations. These reductions are slightly greater than 25% reduction in sevoflurane usage achieved in human paediatric anaesthesia through a quality improvement initiative (Glenski & Levine 2020) and the 21% reduction in isoflurane using an inhalational anaesthetic computer simulation (Feldman 2012). However, it should be noted both these studies involved reduction of fresh gas flow in circle systems to 1 l/min from a standard of 2 l/min rather than a shift from non‐rebreathing systems to low‐flow techniques (Feldman 2012, Glenski & Levine 2020).…”

The effect of low flow anesthesia with sevoflurane on oxidative status

“… 14 , 15 In numerous studies carried out with high-flow anesthesia, it has been demonstrated that anesthetic gas and oxygen consumption was significantly higher compared to low-flow anesthesia. 16 , 17 Tissues exposed to high oxygen produce reactive oxygen. Oxidative cell damage often causes cells to die by disrupting their integrity, causing microvascular and alveolar disruption.…”