Most anesthesia providers recognize the benefits of practicing low flow anesthesia, but only a small percentage utilize the practice consistently. That’s according to a new survey of more than 200 anesthesiologists and CRNAs conducted independently by Sage Growth Partners[1].
The survey found that 83% of practice anesthesiologists believe broader adoption of low-flow anesthesia would reduce anesthesia costs, and 74% say it would support environmental sustainability efforts. Only 14%, however, say low flow anesthesia is administered in more than 90% of all cases within their organization.
What is low flow anesthesia?
Within the survey, low flow anesthesia was defined as reducing gas flow to the lowest level consistent with equipment capabilities and safe and effective patient care (often resulting in mean fresh gas flow rates below 1 liter per minute).
What’s contributing to the low rate of utilization of low flow anesthesia? While a variety of factors are at play, one of the biggest reasons is that administering low flow anesthesia has, traditionally, required a manual approach that places a large cognitive burden on anesthesia providers. The approach requires continuous monitoring of airway gases, as well as regular adjustments to gas flow, in order to ensure the appropriate mix of anesthesia and oxygen is provided. In fact, managing gas flows associated with low flow is so complex that it has been previously referred to as “the art and practice of low flow anesthesia”[2].
New automation technology recently approved by the FDA, however, has reduced this complexity and the associated burden on providers. The technology streamlines the administration of anesthesia by automating low flow rates and it greatly reduces the frequency of manual adjustments required[3]. As a result, the technology is likely to play a key role in helping to drive broader utilization of low flow anesthesia.
From Manual to Automated: A Closer Look at the New Approach
The automation technology, known as End-tidal Control, earned FDA approval in April of 2022.* End-tidal Control enables anesthesia providers to set targets for oxygen and anesthetic agents for each individual patient. The software then maintains those targets automatically throughout the patient’s surgery, as guided by the anesthesia professional to meet the needs of the patient[4]. This nearly eliminates any need for manual adjustments of individual gases and helps ensure an appropriate mix of anesthesia and oxygen.
The FDA approval for End-tidal Control was supported by the results from a U.S.-based, multi-center, multi-year clinical trial that included over 200 patients. In the clinical trial, over 80% of users said End-tidal Control is easier to use than manual fresh gas control, and that it required fewer adjustments to obtain the desired result. The trial also found that 98% of the time when using this feature end tidal anesthetic concentration was within acceptable limits, compared to about 46% when not using End-tidal Control[5].
Benefits of Automated Low Flow Anesthesia: Broader Utilization, More Impact
Hospitals in Europe have been using End-tidal Control for more than a decade, but with the recent FDA approval, a growing number of U.S. organizations are now implementing it[6].
David Hovord, MB BChir, clinical assistant professor and a lead for University of Michigan’s Green Anesthesia Initiative, recently shared his take on the benefits of using End-tidal Control software[7]. “It’s a patient safety tool,” he said. “For us, that's the biggest reason to put it on all of our machines and make it a standard. It makes giving care to patients safer. With this software, we just make one input at the start, and it does what it does and then we can focus entirely on getting the patient ready for the surgery to start.”
As more hospitals implement End-tidal Control, it’s exciting to consider the positive environmental impact that will occur. Today, inhaled anesthetics are significant contributors to greenhouse gas emissions. In fact, hospital operating rooms are the largest consumers of energy and producers of waste, and anesthetic gases constitute approximately half of operating room emissions[8]. Broader adoption of low-flow anesthesia will be a key lever in helping reduce these emissions, with one study finding that the technique can help decrease emissions by as much as 64%[9]. Broader utilization of low flow anesthesia will also lead to cost savings for hospitals and health systems, as less anesthetic gases will be used overall.
Automated Low Flow Anesthesia: A Growing Movement
Over the coming years, more and more anesthesia providers are likely to increase their utilization of low flow anesthesia. In fact, the previously mentioned survey indicates that more than 90% of participating anesthesiologists and CRNAs believe low flow anesthesia is likely to become the “standard of care” within the next decade[10].
Automation technology that streamlines the administration of low flow anesthesia—such as End-tidal Control—will play a critical role in helping that survey finding become the reality.
*End-tidal Control in the United States is indicated for patients 18 years of age and older.
Sources:
1. Double blinded survey conducted independently by Sage Growth Partners in February and March 2024. 215 anesthesiologists and CRNAs participated in the survey.
2. Patient safety and low flow anesthesia, Anesthesia Patient Safety Foundation https://www.apsf.org/article/patient-safety-and-low-flow-anesthesia/
3. GE Healthcare Receives FDA Approval of First-Ever Software to Help Automate Anesthesia Delivery and Reduce Greenhouse Gas Emissions During Surgery
4. GE Healthcare Receives FDA Approval of First-Ever Software to Help Automate Anesthesia Delivery and Reduce Greenhouse Gas Emissions During Surgery
5. Refer to GE HealthCare Et Control Pivotal Study Report DOC2163005. When used as indicated, Et Control is as clinically safe as manual fresh gas control: https://www.gehealthcare.com/-/jssmedia/gehc/us/images/products/anesthesia-delivery/aisys-cs2/redesign/whitepaper-etcontrol-arc-anesthesia-jb22327xx.pdf?rev=-1&hash=8BC4481E4D2F46747C2418D8AE7707F9
6. Green Anesthesia: New Software Reduces Surgery’s Carbon Footprint by up to 44%, GE HealthCare https://www.gehealthcare.com/insights/article/green-anesthesia-new-software-reduces-surgery%E2%80%99s-carbon-footprint-by-up-to-44
7. Green Anesthesia: New Software Reduces Surgery’s Carbon Footprint by up to 44%, GE HealthCare https://www.gehealthcare.com/insights/article/green-anesthesia-new-software-reduces-surgery%E2%80%99s-carbon-footprint-by-up-to-44
8. Going green in the operating room reduces cost and improves environmental impact, Journal of the American College of Surgeons
9. The anesthesiologist and global climate change: an ethical obligation to act, Current Opinion in Anesthesiology
https://pubmed.ncbi.nlm.nih.gov/32628406/
10. Double blinded survey conducted independently by Sage Growth Partners in February and March 2024. 215 anesthesiologists and CRNAs participated in the survey.
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John "JW" Beard, MD, MBA
John “JW” Beard, MD, APSF board Member and Chief Medical Officer of GE HealthCare – Patient Care Solutions. Prior to entering the medical industry, Dr. Beard was in clinical practice for fifteen years as an anesthesiologist. While in clinical practice, Dr. Beard led multiple quality improvement initiatives and held leadership positions including Chairman and Medical Director of the Department of Anesthesia.