British journal of anaesthesia
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What's the deal?
This lab study from Zhong et al. challenges the assumption that low-flow anaesthesia is economically and environmentally superior during TIVA anaesthetics when volatile agents are not used.
What did they do?
Zhong used a test lung model with fixed CO2 inflow (250 ml/min) ventilated via circle systems of two anaesthetic machines (Dräger Primus and GE Aisys CS2). FGF rates of 1, 2, 4, and 6 L/min were tested, measuring the time to CO2 absorbent exhaustion (when inspired CO2 >0.3 kPa).
An inspired 30% O2/air mixture was used, with the test lung volume-control-ventilated at 12 bpm with 500 mL tidal volumes.
Findings
Results showed that increasing FGF from 1 to 6 L/min resulted in over 90% reduction in running costs with minimal net change to global warming potential. The time to absorbent exhaustion increased non-linearly with higher FGFs, taking over 5-8 days at 6 L/min. Notably, removing the CO2 absorbent entirely and using very high FGF (15-18 L/min) provided minimal additional economic benefit while more than doubling the environmental impact.
"We suggest that 'high-flow anaesthesia', with FGF around 6 L/min, is a viable cost-saving strategy when using a circle system for anaesthetic maintenance without inhalational anaesthetic agents in adults."
Hang-on...
The absolute cost saving (due to reduced soda lime consumption) was actually pretty small, being less than 4% of the total non-staff anaesthetic cost. Although this might still be economically significant when scaled across an entire health system, especially given the simplicity of implementation and the lack of drawback.
Bottom-line
When using total intravenous anaesthesia with modern HME filters, higher fresh gas flows (~6 L/min) are more cost-effective than traditional low-flow techniques, without compromising environmental impact or patient safety.
summary -
Randomized Controlled Trial
Evaluation of the intratidal compliance profile at different PEEP levels in children with healthy lungs: a prospective, crossover study.
Optimal intraoperative lung protective ventilation (LPV) strategies in young children are largely under-explored. Individualised PEEP levels are likely to contribute to optimal lung protection. We determined optimal PEEP levels in young children during general anaesthesia by evaluating changes in intratidal compliance with varying PEEP. ⋯ NCT03533296.
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Review Comparative Study
Lactate versus acetate buffered intravenous crystalloid solutions: a scoping review.
Buffered crystalloid solutions are increasingly recommended as first-line intravenous resuscitation fluids. However, guidelines do not distinguish between the different types of buffered solutions. The aim of this scoping review was to assess the evidence on the use of lactate- vs acetate-buffered crystalloid solutions and their potential benefits and harms. ⋯ The quantity and quality of evidence on the use of different buffered crystalloid intravenous solutions were low, data were derived primarily from surgical settings, and patient-important outcomes were rarely reported; thus, the balance between benefits and harms between these solutions is largely unknown.
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The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. ⋯ Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.