Low flow anesthesia implementation program in Ankara University Medical Faculty hospitals

Purpose: In this study; it was aimed to investigate the effect of the applications consisting of theoretical education, reminder messages and individual feedback on the frequency of application in low flow anesthesia in the short and medium term. The secondary aim of the study is to investigate the effect of the applications consisting of theoretical education, reminder messages and individual feedback on the amount of inhaled anesthetic agent consumed in the short and medium term. Materials and Methods: In Ankara University Medical Faculty (AUMF) Hospital operating rooms; Patients who underwent general anesthesia between November 2022 and December 2022 were included in the study. After the approval of the ethics committee for the study, the research assistants of the AUMF Anesthesiology and Reanimation Department were trained for a practical low-flow training for 1 day at a predetermined date. Research assistants who could not attend or complete the training were excluded from the study. Data were collected during the first 8 weeks from the start of the training. The data follow-up form was filled out separately for each anesthesia application. The data follow-up form was filled out at the end of the case by anesthesia technicians working with anesthesiology research assistants. In the data follow-up form, the date of the operation, demographic data of the operated patient, the name of the anesthesia assistant who determined the low flow or normal flow application, the type of flow applied and the reason for choosing the applied flow were recorded. At the beginning of the first week, at the end of the second week, and at the beginning of the fourth week of the study, a reminder message was sent to the research assistants by the study supervisors via the WhatsApp group, and the questions from the assistants were answered during the day. During the study period, the stock status of inhalation anesthetics was monitored in all anesthesia warehouses and the amounts of inhaled anesthetic drugs used weekly were recorded. Results: In our study, 45 patients (17.9%) in the first week, 47 patients (18.8%) in the second week, 50 patients (19.9%) in the third week, 54 patients (21.5%) in the fourth week and 55 patients (21.9%) in the fifth week, total of 251 patients were included. In our study, 155 (61.8%) of the residents were in their 1-2 year of education, 52 (20.7%) were in their 3-4th year, and 44 (17.5%) were in their 5th year. The percentage of low flow anesthesia in the previous month was 10%. The current low flow anesthesia rate was found to be 36.3%. The current low flow anesthesia percentage was found to be significantly higher than the previous month (p<0.001). Differences between variables were examined for low and normal flow groups. A significant difference was found in terms of age and 6 questions asked to residents (p=0.040, p<0.001, p<0.001, p<0.001, p<0.001, p=0.028 and p=0.003, respectively). The mean age of residents using low-flow anesthesia was significantly higher than residents using high-flow anesthesia. Differences were examined in terms of the questions asked to the residents for the training period, only a significant difference was found in terms of the answers given to the question of lack of experience (p=0.002). A significant relationship was found between the education period of the residents and the flow type (p=0.048). Conclusion: The rates of low flow anesthesia in AUMF Hospitals increased significantly compared to the previous month. In the light of all these data, it has been observed that the rate of low flow anesthesia can be increased and become permanent by eliminating the lack of knowledge and creating awareness among the research assistants. Thus, the amount of inhaler anesthetic gas used is reduced. Key Words: General anesthesia, low flow anesthesia, sevoflurane, desflurane