Healthy Patients, Healthy Planet: How Semi-automated Anesthesia Will Improve the Surgery Experience and Reduce Greenhouse Emissions

Anesthesiologists and nurse anesthetists take pride in guaranteeing nervous patients that they’ll be asleep and unable to feel pain during surgery. But what most patients don’t know is that general anesthesia has become safer through a decades long effort combining training, research and the specialty’s adoption of advanced technologies. Today the administration of anesthetic agent, painkiller and oxygen is guided by continuous, real-time monitoring which allows for constant adjustments to ensure a patient is getting the right amount of each.

This is why it’s big news for anyone with experience in the operating room that America’s Food and Drug Administration (FDA) has just approved software that semi-automates the process of dialing in the levels of anesthetic and oxygen in patients. Called “End-tidal Control,” the technology uses continuous gas analysis, data, and powerful algorithms to precisely maintain the levels of oxygen and anesthetic agent targeted by the anesthesia provider during surgery. It’s also big news for the environment because the technology has been associated with reduced utilization of anesthetic agents which are often powerful greenhouse gases that contribute to climate change.

The FDA’s approval of this software comes just in time for this year’s World Health Day (April 7), which seeks to focus attention on the link between our environment and our healthcare. Anesthetics like sevoflurane and desflurane are expensive and End-tidal Control has been shown in studies to reduce the amount of anesthetic needed, resulting in potential cost reductions up to 27%.[1] Anesthetic that patients don’t absorb can end up in the atmosphere.[2] Given that a quarter of all operating room waste is anesthesia-related, and anesthesia is administered by a GE Healthcare machine every 0.2 seconds somewhere in the world today, the savings to both the economy and the environment aren’t small.[3] In fact, End-tidal Control was estimated in one study to reduce anesthesia-related greenhouse gas emissions by as much as 44%.[4]

The world's anesthesiologists are increasingly aware of the impact their decisions have on the environment. Where doctors might once have considered only the benefits to a patient, they're now thinking about their carbon footprint as well and demanding better options for reducing waste[5]. A 2020 scholarly review argued that the anesthesia provider community has an ethical obligation to act now and that better control over anesthetic gas reduces the equivalent CO2 emissions from the procedure by nearly two thirds[6]. And late last year a world federation of anesthesiologists declared an intention to move toward an environmentally sustainable practice[7].

Technology has already dramatically improved the practice of administering general anesthesia, essentially the science of ensuring that patients are asleep, don’t feel pain and remain motionless during surgery. Anesthetic is typically administered by machines that blend an inhaled anesthetic agent into a mixture of air and oxygen, deliver it into the patient’s lungs and collect waste gas and unused anesthetic so it doesn’t leak into the operating room where the staff is working.

The FDA’s approval of End-tidal Control for the U.S. comes 10 years after European hospitals started using GE’s Aisys CS² with End-tidal Control to administer anesthetic and oxygen in precise amounts. End-tidal Control is now used in over 100 countries, where its efficiency and effectiveness have been proven. Studies have shown that using the software doesn’t just save anesthetic, it’s more efficient to manual adjustments at maintaining anesthesia to the level determined by the anesthesia provider as most appropriate for that patient. It even significantly reduces the number of steps, measured as key presses, that anesthesia providers must ordinarily do to maintain anesthetic levels with anesthesia machines that don’t have End-tidal Control.[8]

Advanced anesthetic machines such as Aisys CS² go a step further and also collect tons of data while the machine is operating, enabling a suite of software applications that, for example, help hospitals identify opportunities to gain efficiency, improve anesthetic utilization and know which machines are ready for surgery.[9] 

Anesthesia providers start by selecting the concentrations of drugs and oxygen they want to achieve. “But it's not simple,” says Juan Pablo Gomez, senior research manager at GE Healthcare. “Because even if you try to put exactly that concentration of drug into the patient, the patient will capture some percentage of that and then the rest he or she will exhale.” As much as 95% of the anesthetic agent will not be absorbed and must be captured by the machine and either recirculated to the patient or safely removed from the breathing apparatus.

End-tidal Control takes digital insights to where they’re most effective by adding real-time measurement of how much anesthetic and oxygen patients are exhaling, feeding that data into an algorithm that tells the machine to adjust the amounts of each up or down. Without End-tidal Control, anesthesia providers must keep a close eye on a patient’s anesthetic and oxygen levels throughout surgery, making manual adjustments, all while attending to a multitude of tasks for the patient and surgical team. The manual adjustment processes may lead to variability in how much anesthetic is delivered.

“The most important measure of an anesthetic and surgery is the patient outcome. Historically there has been variability in how you got there,” says Mike Foulis, anesthesia product manager at GE Healthcare. A typical surgery using manual anesthetic control might start with the anesthesia provider administering an anesthetic at a high dose to get it into a patient quickly so that the rest of the surgery staff can begin, before reducing the dose at a later time. “With End-tidal Control, anesthesia providers are now able to embrace a more precise practice,” says John Beard, M.D., chief medical officer at GE Healthcare Life Care Solutions. “End-tidal Control is standardizing [care] so that it's more tailored to the individualized anesthetic level considered most appropriate for that patient.”

 

 

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