LOW-FLOW ANESTHESIA
EMPOWERING THE CAREGIVER
Anesthesia Patient Safety Foundation Technology Education Initiative
In Collaboration with the American Society of Anesthesiologists
Jeffrey M. Feldman, MD, MSE
Professor of Clinical Anesthesiology
Children’s Hospital of Philadelphia
Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA
MPOG & “GREENING” PRACTICE
• Inhalation anesthesia is a good place to start
• Desflurane and Nitrous Oxide have the greatest negative impact
• Is the clinical benefit sufficient to warrant the environmental impact?
• Minimize the environmental impact of the inhalation agents while
achieving clinical goals
• SUS Metrics – Maintenance of Anesthesia
• Proposed SUS-06 Pedes: Induction Metric
LOW-FLOW ANESTHESIA BEYOND MAINTENANCE
Efficiency of Anesthetic Delivery
Anesthetic Uptake / Anesthetic Delivered
28%
46%
BARRIERS TO PRACTICING LOW-FLOW ANESTHESIA
• Sufficient oxygen delivery
• Adequate anesthetic depth
• Rate of change of circuit concentrations
• Sevoflurane Package Insert (medically obsolete)
• Not less than 1 L/min FGF up to 2 MAC-Hrs
• Not less then 2 L/min FGF for longer
• ECONOMICS ARE NOT A BARRIER TO WASTE!
APSF/ASA COURSE ON LOW-FLOW ANESTHESIA
https://www.apsf.org/apsf-technology-
education-initiative/low-flow-anesthesia/
https://education.asahq.org/course/view.php?
id=4353
LOW-FLOW ANESTHESIA
DEFINITION: The practice of reducing fresh gas flow
below minute ventilation
to the lowest level consistent with
equipment capabilities and provider comfort
, while
ensuring safe and effective
care for the patient.
GOAL
: Empower the anesthesia professional with the
knowledge required to comfortably begin to reduce FGF.
LEARNING OBJECTIVES
• Understand why the gas mixture and anesthetic concentration set on the
anesthesia machine are not what the patient actually inspires during low flow
anesthesia
• Understand how to minimize anesthetic waste and environmental pollution during
induction, maintenance and emergence.
• Understand how to manage total fresh gas flow, FGF composition and vaporizer
settings during induction, maintenance and emergence to achieve desired inspired
oxygen and end-expired anesthetic concentrations
COURSE TOPICS
GUIDED SIMULATION
GUIDED MACHINE SIMULATION
PLOTTING FUNCTION
PLOTTING FUNCTION
CONCLUSIONS
• Appreciation to the Low-Flow Course Development Team
• Links to the course:
• Technology Education Initiative
• Apsf.org/TEI
• Low-Flow Course and Information
• https://www.apsf.org/apsf-technology-education-
initiative/low-flow-anesthesia/
• ASA Education Center
• https://education.asahq.org/course/view.php?id=4353
• Assessing the impact of the course – Role
for MPOG?
