Low-flow anaesthesia - underused mode towards "sustainable anaesthesia"

Madhusudan Upadya, P J Saneesh, Madhusudan Upadya, P J Saneesh

Abstract

Any technique that employs a fresh gas flow that is less than the alveolar ventilation can be classified as low-flow anaesthesia. The complexities involved in the calculation of uptake of anaesthetic agents during the closed-circuit anaesthesia made this technique less popular. However, the awareness of the dangers of theatre pollution with trace amounts of the anaesthetic agents and the prohibitively high cost of the new inhalational agents, have helped in the rediscovery of low-flow anaesthesia. Moreover, the time has arrived for each of us, the practicing anaesthesiologists, to move towards the practice of low-flow anaesthesia, to achieve lesser theatre and environmental pollution and also to make anaesthesia more economical. The article also reviews low-flow anaesthesia (LFA) in paediatrics, recent advances such as automated LFA and updates on currently undergoing research to retrieve and reuse anaesthetic agents.

Keywords: Economical; environmental; low-flow anaesthesia; rebreathing; sustainable anaesthesia.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
The Gothenburg technique of conducting low-flow anaesthesia

References

    1. Sherman JD, Ryan S. Ecological responsibility in anesthesia practice. Int Anesthesiol Clin. 2010;48:139–51.
    1. Snow J. On narcotism by the inhalation of vapours. Part XV. The effects of chloroform and ether prolonged by causing the exhaled vapour to be reinspired. Lond Med Gaz. 1850;11:749–54.
    1. Waters RM. Clinical scope and utility of carbon dioxide filtration in inhalation anaesthesia. Anesth Analg. 1924;3:20–2.
    1. Baum JA. Who introduced the rebreathing system into clinical practice? In: Schulte Am Esch J, Goerig M, editors. Proceedings of the Fourth International Symposium on the History of Anaesthesia. Lübeck: Dräger; 1998. pp. 441–50.
    1. Onishchuk JL. The early history of low-flow anaesthesia. In: Fink BR, Morris LE, Stephen CR, editors. The History of Anesthesia. Third International Symposium, Proceedings. Park Ridge, Illinois: Wood Library-Museum of Anesthesiology; 1992. pp. 308–13.
    1. Virtue RW. Minimal-flow nitrous oxide Anesthesia. Anesthesiology. 1974;40:196–8.
    1. Aldrete JA, Lowe HJ, Virtue RW. Low Flow and Closed System Anaesthesia. New York, San Francisco, London: Grune & Stratton; 1979.
    1. Lowe HJ, Ernst EA. The Quantitative Practice of Anesthesia: Use of Closed Circuit. Baltimore: Williams & Wilkins; 1981. pp. 67–97.
    1. Logan M, Farmer JG. Anaesthesia and the ozone layer. Br J Anaesth. 1989;63:645–7.
    1. Kleemann PP. The climatisation of anesthetic gases under conditions of high flow to low flow. Acta Anaesthesiol Belg. 1990;41:189–200.
    1. Baum JA, Aitkenhead AR. Low-flow anaesthesia. Anaesthesia. 1995;50(Suppl 10):37–44.
    1. Eger EI., 2nd Economic analysis and pharmaceutical policy: A consideration of the economics of the use of desflurane. Anaesthesia. 1995;50(Suppl 10):45–8.
    1. Lachmann B. Xenon anesthesia: Prerequisite for its use in a closed circuit system. Appl Cardiopulm Pathophysiol. 1995;5(Suppl 2):59–61.
    1. Baker AB. Back to basics – A simplified non-mathematical approach to low flow techniques in anaesthesia. Anaesth Intensive Care. 1994;22:394–5.
    1. Ultane (sevoflurane) volatile liquid for inhalation. Food and Drug Administration. [Last accessed on 2018 Jan 12]. Available from: .
    1. Kleiber M. Body size and metabolic rate. Physiol Rev. 1945;27:511–39.
    1. Severinghaus JW. The rate of uptake of nitrous oxide in man. J Clin Invest. 1954;33:1183–9.
    1. Fröhlich D, Schwall B, Funk W, Hobbhahn J. Laryngeal mask airway and uncuffed tracheal tubes are equally effective for low flow or closed system anaesthesia in children. Br J Anaesth. 1997;79:289–92.
    1. Frink EJ, Jr, Green WB, Jr, Brown EA, Malcomson M, Hammond LC, Valencia FG, et al. Compound A concentrations during sevoflurane anesthesia in children. Anesthesiology. 1996;84:566–71.
    1. Dale O, Stenqvist O. Low flow anaesthesia: Available today – A routine tomorrow. Surv Anesthesiol. 1992;36:334–6.
    1. Meyer JU, Kullik G, Wruck N, Kück K, Manigel J. Advanced technologies and devices for inhalational anesthetic drug dosing. Handb Exp Pharmacol. 2008;182:451–70.
    1. Dehouwer A, Carette R, De Ridder S, De Wolf AM, Hendrickx JF. Accuracy of inhaled agent usage displays of automated target control anesthesia machines. J Clin Monit Comput. 2016;30(5):539–43.
    1. Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: Application to clinical use. Anesth Analg. 2010;111:92–8.
    1. Doyle DJ, Byrick R, Filipovic D, Cashin F. Silica zeolite scavenging of exhaled isoflurane: A preliminary report. Can J Anaesth. 2002;49:799–804.
    1. Mehrata M, Moralejo C, Anderson WA. Adsorbent comparisons for anesthetic gas capture in hospital air emissions. J Environ Sci Health A Tox Hazard Subst Environ Eng. 2016;51:805–9.
    1. Baum JA, Nunn G. English Text Revised. Oxford: Butterworth Heinemann; 1996. Low-flow anaesthesia. The theory and practice of low-flow, minimal flow and closed system anaesthesia.
    1. Baum J, Berghoff M, Stanke HG, Petermeyer M, Kalff G. Low-flow anesthesia with desflurane. Anaesthesist. 1997;46:287–93.

Source: PubMed

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