ISSUE 7 – 2024

HOW TO BE A PART OF THE SOLUTION

In the interest of doing all we can as a part of our everyday anesthesia care, this issue of Sustainability in The OR is dedicated to our top takeaways from 2023.

Provide regional anesthesia whenever appropriate. This may create a scenario where moderate sedation would suffice instead of general anesthesia. At the very least, regional blocks should substantially reduce the amount of additional anesthesia required.

Utilize TIVA as much as possible (while carefully minimizing drug waste).

• Exclusively use TIVA for bronchoscopy procedures or other procedures with circuit leaks.
• Read More: Anesthesia Sustainability During Bronchoscopies

Reduce total fresh gas flow to 1.0 L/M or less during the maintenance of anesthesia with volatile anesthetic.

• Use Amsorb or a similar CO2 absorbent with < 2% NaOH and no KOH.
• Make sure the bellows fill between each breath.
• Observe & maintain the FiO2 that provides for adequate SaO2.
• Read More: Reducing Fresh Gas Flow With An Eye On Sustainability
• Learn More: Go to the APSF Low-Flow Anesthesia Course
  
  

Stick with Sevoflurane when delivering a volatile anesthetic agent.

• Do NOT use Desflurane (20X worse GHG).
• Avoid using N2O (Ozone-depleter, 3X worse GHG) unless it is essential for patient care.
• Read More: Choosing The Right Inhaled Anesthetic

Conserve oxygen wherever and whenever possible.

• Remember, you don’t need 10 – 15 L/M fresh oxygen flow during preoxygenation, induction, or emergence.
• Also, when using the auxiliary oxygen with face masks, remember to turn down the machine’s fresh gas flow to its minimum (0.15 L/M)
• Read More: Conserving Oxygen

Avoid adding volatile agent during induction due to high fresh gas flow.

• Consider giving more of your IV induction agent instead.
• Some providers begin the TIVA infusions immediately after the induction bolus.
• Read More: Further Reduction of Oxygen and Volatile Agent Waste

Choose IV anesthetic/analgesic boluses to rapidly increase the depth of anesthesia.

• If you prefer to use volatile agent, carefully deliver high concentration at low flow.
• Read More: Rapidly Increase MAC Using The Hands-on Technique

If you haven’t done so already, please practice these easy, effective tips in your everyday anesthesia care and encourage your anesthesia coworkers to do the same. Thank you!

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Next time in Sustainability in the OR:
“Reducing Pharmaceutical and Material Waste”
Until then, be well. Adam

Connect & learn more

APSF Low-Flow Anesthesia Course

Become a low-flow anesthesia expert and earn CME’s!
Complete this hands-on low-flow anesthesia course (if you haven’t done so already).  Earn CMEs through APSF.org.

Low-Flow Anesthesia – Anesthesia Patient Safety Foundation
This APSF module will greatly assist you in becoming much more comfortable with the concepts of safe delivery of low-flow anesthesia. Low-flow anesthesia maintenance is the single best clinical practice for us to make the most of our contribution toward protecting our planet.

If you haven’t done so already, please consider completing this activity and gradually apply what you have learned to your practice.

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“We did not inherit this earth; we are borrowing it from our children.”
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