Cover story - advertising feature
10 expert tips for reducing volatile anaesthetic emissions
Automated low-flow anaesthesia: less anaesthetic gas, fewer emissions Low-flow anaesthesia, supported by Automatic Gas Control (AGC) to regulate oxygen delivery, has the power to safely reduce anaesthetic agent consumption by up to 58%.11,12 Two hospitals in Belfast, UK, recently reduced their volatile agent use by 30.5%13
and 42%,
respectively, achieving significant cost savings. Belfast City Hospital projected annual savings of €30,394 across seven anaesthesia workstations, with a return on investment for the software upgrade in under a year. At Imelda Hospital in Bonheiden, Belgium, the anaesthesia department cut its ecological footprint by over 1,600,000 kg of CO2
equivalents.
“The average footprint per person in the Western world is about 10,000 kg annually. Our adjusted practices enable us to reduce the equivalent of
more than 160 people,” said Dr. Guy Schols, Head of Anaesthesia.
Power feature: Automatic Gas Control (AGC) Automatic Gas Control (AGC) is a software feature that regulates fresh gas and anaesthetic concentration to reach target values for inspired oxygen (FIO2
) and end-tidal agent
concentration (EtAA). Once these targets are met, AGC automatically reduces the fresh gas
Low-flow anaesthesia: the benefits
As early as 1924, R.M. Waters published an article in Anesthesia & Analgesia highlighting the benefits of using a rebreathing system in anaesthesia: improved economy, convenience, and patient welfare.15
Nearly a century later,
these benefits are still true, and with today’s focus on sustainability, low-flow anaesthesia also protects the welfare of our planet. In low-flow anaesthesia, the rebreathing
system uses a fresh gas flow (FGF) lower than the patient’s alveolar ventilation. This technique uses less anaesthetic agents than conventional systems, emits less gas into the atmosphere, and improves the flow dynamics of inhaled air. Low flow is generally characterised by a fresh gas flow of less than 1.0 L/min. In minimal flow, the FGF is decreased to 0.5 L/min. The benefits include: Economy: Agent expenditure accounts for a large part of the total cost of ownership
of anaesthesia machines. Reducing the anaesthetic agent consumption in your operating room (OR) will have a positive impact on your overall hospital expenditure. Environmental impact: With low-flow anaesthesia, a reduced amount of anaesthetic gas is released into the atmosphere, lowering the environmental impact of fluorinated agents and nitrous oxide. This contributes to decreased ozone depletion and reduced greenhouse gas emissions. Patient comfort and safety: Low FGF improves the flow dynamics of inhaled gases, increases mucociliary clearance, maintains body temperature and reduces water loss. OR staff safety: With less unused surplus gas discharged into the atmosphere, the concentration of anaesthesia gas in the OR is greatly reduced. This minimises occupational risk for OR staff.
and anaesthetic delivery to a minimum. A speed and prediction tool provides insight into the expected course of anaesthesia, enabling safe and effective low-flow application. Dr. Jan Hendrickx, anaesthetist at OLV Hospital in Aalst, Belgium, explains: “Instead of manually adjusting fresh gas flow and vaporiser settings to maintain target concentrations, a workstation equipped with AGC does this automatically. This allows clinicians to minimise fresh gas flow and anaesthetic gas waste.”
Conclusion Prioritising anaesthetic gas reduction over recycling is a strategic decision that enables both cost savings and a measurable reduction in a hospital’s carbon footprint. With low-flow anaesthesia and automated gas control, this approach is not only feasible but safe. Clinicians can reduce gas use, cut greenhouse gas emissions, and lower costs – without compromising care.
References are available upon request.
Volatile anaesthetics are potent greenhouse gases. Their targeted reduction is not only economically sensible, but also an important step toward environmental sustainability. Prof. Dr. Jan Hendrickx, an expert in the kinetics of inhaled anaesthetics and carrier gases, shares his recommendations on how hospitals can minimise the environmental impact of anaesthesia gases. He recommends the following actions: 1. Apply minimal-flow anaesthesia. 2. Do not use desflurane. 3. Minimise the use of N2
O.
4. Use propofol instead of inhalation agents before securing the airway, in order to deepen anaesthesia during intubation or laryngeal mask insertion.
5. Minimise the use of fresh gas flow (FGF)
above the minute ventilation interval; exceptions only during washout at specific workstations.
6. During wash-in, use a low FGF (1 L/min or less) with a high vaporiser setting, and monitor anaesthesia depth using tools such as MAC Brain, EEG, indices, and/or PK/PD visualisation tools.
7. Use target control flow to precisely manage gas flow.
8. Minimise the concentration of expired agent to 0.8 MAC and ensure age correction.
9. Titrate opioids appropriately and use the synergy between opioids and inhalation agents to maintain 0.8 MAC. Higher concentrations delay emergence and waste anaesthetic gases.
10. Coasting.14
Getinge Limited, Unit 3 Indurent Park, Andressey Way, Chaddesden, Derby DE21 6YH
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getinge.com December 2025 I
www.clinicalservicesjournal.com 7
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