Semester

Summer

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Angela Jeffries

Committee Co-Chair

Aaron Ostrowski

Committee Member

Kelly Meyers

Committee Member

Eric Likar

Committee Member

Ubolrat Piamjariyakul

Abstract

Abstract

An Initiative to Improve Sevoflurane Gas Flows Among Anesthesia Providers in an

Academic Medical Center

Amy DiNicola

Background: While global warming has been introduced as the most significant public health threat of the 21st century, 10% of carbon emissions in the United States come from healthcare (Shoham et al., 2022). Sevoflurane is a volatile anesthetic gas that requires a carrier gas mixture of oxygen with air or nitrous oxide to reach a patient during anesthesia. The extra gas flow often exceeds physiologic needs, and the excess gets wasted into the atmosphere. Reducing the additional flow of carrier gas can reduce the amount of gas wasted in the atmosphere.

Local Problem: Dr. Kelly Meyers of West Virginia University Ruby Memorial Hospital’s anesthesia department has identified moderate to high fresh gas flow usage as an ongoing problem within the operating rooms (K. Meyers, personal communication, March 30, 2023). Fresh gas flows in clinical practice at Ruby Memorial continue to range from 3 to more than 9L/min (K. Meyers, personal communication, July 19, 2023).

Methods: This quality improvement project provided education and information on low-flow sevoflurane use through intermittent academic detailing of evidence-based practice using low fresh gas flows with sevoflurane.

Intervention: An educational presentation was created and shared with the anesthesia providers at the large academic center on lower fresh gas flows with sevoflurane use. The presentation was followed by educational follow-up throughout the implementation phase, including dissemination of a journal article, follow-up emails, and using a low-flow board in the anesthesia lounge for stakeholder engagement. A post-education survey assessed acceptability among anesthesia providers. A monthly random sampling of 200 same-day-surgery adults (>18 years old) cases using general anesthesia with sevoflurane lasting 240 minutes or less was completed. The baseline data before educational interventions were compared with each month’s data for average fresh gas flow, total fresh gas volume in liters, average sevoflurane rate, total sevoflurane use in liters, and total sevoflurane run time. These data sets were analyzed using T-test.

Results: Provider acceptability, feasibility, and appropriateness were measured using the average means of the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) questionnaires. The average fresh gas flow decreased from the baseline month 1 to month 3, attaining statistical significance with a decrease of 7.32%.

Conclusions: Educational interventions increase anesthesia provider acceptability, feasibility, and appropriateness of use regarding low fresh gas flows with sevoflurane in adult same-day-surgery patients. Reducing fresh gas flows with sevoflurane use can improve waste anesthesia gases and reduce their environmental impact.

Keywords: Sevoflurane, fresh gas flows, evidence-based practice, sustainability, green anesthesia, greenhouse gases

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