title: Reducing wastage of inhalation anesthetics using real-time decision support to notify of excessive fresh gas flow.
abstract: BACKGROUND
  Reduced consumption of inhalation anesthetics can be safely achieved by reducing excess fresh gas flow (FGF). In this study the authors describe the use of a real-time decision support tool to reduce excess FGF to lower, less wasteful levels.
  
  
  METHODS
  The authors applied a decision support tool called the Smart Anesthesia Manager™ (University of Washington, Seattle, WA) that analyzes real-time data from an Anesthesia Information Management System to notify the anesthesia team if FGF exceeds 1 l/min. If sevoflurane consumption reached 2 minimum alveolar concentration-hour under low flow anesthesia (FGF < 2 l/min), a second message was generated to increase FGF to 2 l/min, to comply with Food and Drug Administration guidelines. To evaluate the tool, mean FGF between surgical incision and the end of procedure was compared in four phases: (1) a baseline period before instituting decision rules, (2) Intervention-1 when decision support to reduce FGF was applied, (3) Intervention-2 when the decision rule to reduce flow was deliberately inactivated, and (4) Intervention-3 when decision rules were reactivated.
  
  
  RESULTS
  The mean ± SD FGF reduced from 2.10 ± 1.12 l/min (n = 1,714) during baseline to 1.60 ± 1.01 l/min (n = 2,232) when decision rules were instituted (P < 0.001). When the decision rule to reduce flow was inactivated, mean FGF increased to 1.87 ± 1.15 l/min (n = 1,732) (P < 0.001), with an increasing trend in FGF of 0.1 l/min/month (P = 0.02). On reactivating the decision rules, the mean FGF came down to 1.59 ± 1.02 l/min (n = 1,845). Through the Smart Anesthesia Messenger™ system, the authors saved 9.5 l of sevoflurane, 6.0 l of desflurane, and 0.8 l isoflurane per month, translating to an annual savings of $104,916.
  
  
  CONCLUSIONS
  Real-time notification is an effective way to reduce inhalation agent usage through decreased excess FGFs.
authors: Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington 98195, USA. nairbg@uw.edu
authors: Bala G
authors: BG
authors: Nair
authors: Gene N
authors: GN
authors: Peterson
authors: Moni B
authors: MB
authors: Neradilek
authors: Shu Fang
authors: SF
authors: Newman
authors: Elaine Y
authors: EY
authors: Huang
authors: Howard A
authors: HA
authors: Schwid
mesh_terms: D000280:Administration, Inhalation; D000769:Anesthesia, Inhalation / Q000295:instrumentation* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage*; D003661:Decision Support Techniques; D000077335:Desflurane; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives; D008738:Methyl Ethers / Q000008:administration & dosage; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane