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Compared to traditional breathing circuits, low-volume anesthesia machines utilize a lower-volume breathing circuit paired with needle injection vaporizers that supply volatile agents into the circuit mainly during inspiration. We aimed to assess whether or not low-volume anesthesia machines, such as the Maquet Flow-i C20 anesthesia workstation (MQ), deliver volatile anesthetics more efficiently than traditional anesthesia machines, such as the GE Aisys CS2 anesthesia machine (GE), and, secondarily, whether this was in a meaningful economic or environmentally conscious way.


Participants enrolled in the study (Institutional Review Board Identifier: 2014-1248) met the following inclusion criteria: 18-65 years old, scheduled for surgery requiring general anesthesia at the University of California Irvine Health, and expected to receive sevoflurane for the duration of the procedure. Exclusion criteria included ageold, a history of chronic obstructive pulmonary disorder, cardiovascular disease, sevoflurane sensitivity, body mass index >30 kg/m2, American Society of Anesthesiologists >2, pregnancy, or surgery scheduled(Student's t-test). There was no suspicion that the low-volume circuit could use more sevoflurane and that the outcome did not answer our research question. One-sided testing allowed for more power to be more certain of smaller differences in our results.


In total, 103 subjects (MQ: n = 52, GE: n = 51) were analyzed. Seven subjects were lost to attrition of different types. Overall, the MQ group consumed significantly less sevoflurane (95.5 ± 49.3 g) compared to the GE group (118.3 ± 62.4 g) (p = 0.043), corresponding to an approximately 20% efficiency improvement in overall agent delivery. When accounting for the fresh gas flow setting, agent concentration, and length of induction, the MQ delivered the volatile agent at a significantly lower rate compared to the GE (7.4 ± 3.2 L/minute vs. 9.1 ± 4.1 L/minute; p = 0.017). Based on these results, we estimate that the MQ can save an estimated average of $239,440 over the expected 10-year machine lifespan. This 20% decrease in CO2 equivalent emissions corresponds to 201 metric tons less greenhouse gas emissions over a decade compared to the GE, which is equivalent to 491,760 miles driven by an average passenger vehicle or 219,881 pounds of coal burned.


Overall, our results from this study suggest that the MQ delivers statistically significantly less (~20%) volatile agent during routine elective surgery using a standardized anesthetic protocol and inclusion/exclusion criteria designed to minimize any patient or provider heterogeneity effects on the results. The results demonstrate an opportunity for economic and environmental benefits.



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Aisys cs2, carbon emissions, environment, flow-i c20, low-volume anesthesia machine, sustainability