Managing fresh gas flow to reduce environmental contamination

Anesth Analg. 2012 May;114(5):1093-101. doi: 10.1213/ANE.0b013e31824eee0d. Epub 2012 Mar 13.


Anesthetic drugs have the potential to contribute to global warming. There is some debate about the overall impact of anesthetic drugs relative to carbon dioxide, but there is no question that practice patterns can limit the degree of environmental contamination. In particular, careful attention to managing fresh gas flow can use anesthetic drugs more efficiently--reducing waste while achieving the same effect on the patient. The environmental impact of a single case may be minimal, but when compounded over an entire career, the manner in which fresh gas flow is managed by each individual practitioner can make a significant difference in the volume of anesthetic gases released into the atmosphere. The maintenance phase of anesthesia is the best opportunity to reduce fresh gas flow because circuit gas concentrations are relatively stable and it is often the longest phase of the procedure. There are, however, methods for managing fresh gas flow during induction and emergence that can reduce the amount of wasted anesthetic vapor. This article provides background information and discusses strategies for managing fresh gas flow during each phase of anesthesia with the goal of reducing waste when using a circle anesthesia system. Monitoring oxygen and anesthetic gas concentrations is essential to implementing these strategies safely and effectively. Future technological advances in anesthetic delivery systems are needed to make it less challenging to manage fresh gas flow.

MeSH terms

  • Anesthesia, Closed-Circuit / methods*
  • Anesthesia, Inhalation
  • Anesthetics, Inhalation / analysis*
  • Carbon Dioxide / analysis
  • Environmental Pollution / prevention & control*
  • Global Warming
  • Hydrocarbons, Fluorinated / analysis
  • Intubation, Intratracheal
  • Oxygen Consumption


  • Anesthetics, Inhalation
  • Hydrocarbons, Fluorinated
  • Carbon Dioxide