Protocol for a safe minimum fresh gas flow practice

Estimate patient oxygen consumption to be 3 to 5 mL/kg/min.

Set total oxygen flow (oxygen + air) to be 20% greater than estimated oxygen consumption.

Add 200 mL/min if using a gas analyzer that does not return sampled gas to the circuit.

Add 100 to 150 mL/min to account for any leaks from the circuit.

Monitor inspired oxygen concentration to ensure adequate oxygen flow. Increase oxygen flow if concentration falls and decrease oxygen flow if concentration increases.

Monitor exhaled anesthetic vapor concentration to ensure adequate MAC.

NOTE: It may be possible to reduce the total fresh gas flow further if the circuit leak is less than 100 mL/min or oxygen consumption is less than the estimated value, but the inspired oxygen concentration must be monitored.

MAC: minimum alveolar concentration.

Adapted from Greening the Operating Room and Perioperative Arena: Environmental Sustainability for Anesthesia Practice, 2014, of the American Society of Anesthesiologists. A copy of the full text can be obtained from ASA, 1061 American Lane, Schaumburg, IL 60173-4973 or online at www.asahq.org.

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Protocol for a safe minimum fresh gas flow practice