Financial and environmental costs of manual versus automated control of end-tidal gas concentrations.
Emerging technologies that reduce the economic and environmental costs of anaesthesia have had limited assessment. We hypothesised that automated control of end-tidal gases, a new feature in anaesthesia machines, will consistently reduce volatile agent consumption cost and greenhouse gas emissions. As part of the planned replacement of anaesthesia machines in a tertiary hospital, we performed a prospective before and after study comparing the cost and greenhouse gas emissions of isoflurane, sevoflurane and desflurane when using manual versus automated control of end-tidal gases. We analysed 3675 general anaesthesia cases with inhalational agents: 1865 using manual control and 1810 using automated control. Volatile agent cost was $18.87/hour using manual control and $13.82/hour using automated control: mean decrease $5.05/hour (95% confidence interval: $0.88-9.22/hour, P=0.0243). The 100-year global warming potential decreased from 23.2 kg/hour of carbon dioxide equivalents to 13.0 kg/hour: mean decrease 10.2 kg/hour (95% confidence interval: 2.7-17.7 kg/hour, P=0.0179). Automated control reduced costs by 27%. Greenhouse gas emissions decreased by 44%, a greater than expected decrease facilitated by a proportional reduction in desflurane use. Automated control of end-tidal gases increases participation in low flow anaesthesia with economic and environmental benefits.
Department of Anaesthesia, Austin Hospital, Melbourne, Victoria, Australia. stanley.tay@nt.gov.au
S
S
Tay
L
L
Weinberg
P
P
Peyton
D
D
Story
J
J
Briedis
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General / Q000191:economics / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000191:economics; D001331:Automation; D002245:Carbon Dioxide / Q000737:chemistry; D002648:Child; D002675:Child, Preschool; D000077335:Desflurane; D016527:Drug Costs; D005260:Female; D057232:Global Warming; D017752:Greenhouse Effect / Q000191:economics / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D007223:Infant; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D002245:Carbon Dioxide; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane