The article by Jeffrey M. Feldman, MD, MSE, focuses on strategies for managing fresh gas flow in anesthesia to minimize environmental contamination and reduce waste. It emphasizes the significant impact that anesthetic gases have on global warming and provides practical advice on how to use these gases more efficiently during different phases of anesthesia.

Key Points:

• Induction Phase: Recommends adjusting fresh gas flow to slightly more than the patient’s minute ventilation during induction to reduce environmental waste while achieving rapid changes in gas concentrations necessary for effective anesthesia.
• Maintenance Phase: Suggests minimizing fresh gas flow once the desired anesthetic concentration is achieved, using the “low flow” or “minimal flow” techniques to maintain effective anesthesia while minimizing waste.
• Emergence Phase: Encourages careful management of fresh gas flow during patient emergence from anesthesia to ensure prompt recovery while reducing the release of anesthetic gases into the environment.
• Technological Integration: Discusses advancements in anesthesia delivery systems that support low flow anesthesia, potentially enhancing the ability to manage gas flows more efficiently and effectively.

Recommendations:

• For induction, use fresh gas flows that match or slightly exceed minute ventilation.
• During maintenance, reduce fresh gas flows to the minimal necessary levels to maintain adequate anesthesia, based on continuous monitoring of oxygen and anesthetic gas concentrations.
• Employ technology and techniques that enable more precise control of anesthetic gas delivery and recovery, reducing overall environmental impact.