To the Editor:

There are many good reasons to encourage reduced fresh gas flows during the administration of volatile anesthetic agents. The recent publication by Nair et al.1  outlines these issues and addresses the twin problems of producing and maintaining a change in fresh gas flows across a large group of providers. Their article then goes on to describe an elegant and robust approach to achieve these objectives.

In the introduction to their article, Nair et al. state that “… providers reverted to original behavior over time,” and cite a number of references to support this. In one of our publications on this topic,2  we found that flow rates continued to decrease over a 5-yr period in the absence of any specific intervention. We have unpublished data showing this trend has continued. We attribute this reduction to a locally developed predictive display system,3,4  which allows the user to easily see the consequence of any combination of fresh gas flow rate and vaporizer setting, along with an indicator of the vapor cost thus simplifying and incentivizing flow reduction.

Although we agree that most studies show that flow rates return to normal, our observations suggest that decision support tools that guide drug administration can be used to enable and support practice in addition to those tools that provide reminders based on monitoring practice.

References

1.
Nair
BG
,
Peterson
GN
,
Neradilek
MB
,
Newman
SF
,
Huang
EY
,
Schwid
HA
:
Reducing wastage of inhalation anesthetics using real-time decision support to notify of excessive fresh gas flow.
Anesthesiology
2013
;
118
:
874
84
2.
Kennedy
RR
,
French
RA
:
Changing patterns in anesthetic fresh gas flow rates over 5 years in a teaching hospital.
Anesth Analg
2008
;
106
:
1487
90
3.
Kennedy
RR
,
McKellow
MA
,
French
RA
:
The effect of predictive display on the control of step changes in effect site sevoflurane levels.
Anaesthesia
2010
;
65
:
826
30
4.
Kennedy
RR
,
French
RA
:
The development of a system to guide volatile anaesthetic administration.
Anaesth Intensive Care
2011
;
39
:
182
90