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TECHNOLOGY, COMPUTING, AND SIMULATION

Changing Patterns in Anesthetic Fresh Gas Flow Rates Over 5 Years in a Teaching Hospital

From the Department of Anaesthesia, Christchurch Hospital and University of Otago, Christchurch, New Zealand.

Address correspondence to R. Ross Kennedy, MB ChB, PhD, FANZCA, Department of Anaesthesia, Christchurch Hospital and University of Otago, Christchurch, Rolleston Ave., Christchurch, New Zealand. Address e-mail to ross.kennedy{at}chmeds.ac.nz.

BACKGROUND: Reducing anesthetic fresh gas flows can reduce volatile anesthetic consumption without affecting drug delivery to the patient. Delivery systems with electronic flow transducers permit the simple and accurate collection of fresh gas flow information. In a 2001 audit of fresh gas flow, we found little response to interventions designed to foster more efficient use of fresh gas. We compared current practice with our earlier results.

METHODS: Flow data were collected in areas with a mix of general and acute surgery in March and November 2001, and again during 2006, by recording directly from the Datex ADU to a computer every 10 s. We extracted the distribution of flow rates when a volatile anesthetic was being administered. Data collection in March 2001 and 2006 was not advertised.

RESULTS: In 2001, the mean flow rates were 1.95 and 2.1 L/min with a median flow of 1.5 L/min. In 2006, the mean was 1.27 and the median in the range 0.5-1.0 L/min. Isoflurane use decreased from 47% in 2001 to 4% in 2006.

CONCLUSIONS: Fresh gas flows used in our department have decreased by 35% over 4 years. Although the absolute change in flow rate is not large, this represents potential annual savings of more than $US130,000. This occurred without specific initiatives, suggesting an evolution in practice towards lower fresh gas flow. Improvements in equipment and monitoring, including a locally developed system, which displays forward predictions of end-tidal and effect-site vapor concentrations, may be factors in this change.