key: cord-0692714-uc6qvz5w
authors: Hall, A.; Chakladar, A.
title: High fresh gas flow during non-inhalational anaesthetics during the COVID-19 pandemic. Comment on Br J Anaesth 2020;
date: 2020-10-02
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.09.033
sha: 399441a767574ceb36d2ae71630d46d93b389d41
doc_id: 692714
cord_uid: uc6qvz5w

nan

Editor -We read with interest Zhong and colleagues' 1 recent article that provided a useful estimation of the cost and environmental benefits of using a 'high-flow' anaesthetic technique without inhalational anaesthetics. However, given the current pandemic status of COVID-19 and surges in case numbers around the world, we wonder if oxygen may be of greater value than just its monetary cost as attributed by the authors. We agree that medical oxygen and air are relatively inexpensive (estimated costs of $0.40 and $0.028 per 1000 L, respectively), and that clinicians must take responsibility to reduce the economic burden and environmental impact of medical care. Of note, this study was conducted in Australia prior to the COVID-19 pandemic; Australia has until recently been relatively spared from the huge numbers of COVID-19 positive patients seen in other countries, and from the impact on healthcare systems related to those numbers.

At 3 South Africa, 4 and India. 5 For a given 6-h case with a circle system, running an inhalational agent-free anaesthetic with fresh gas flows (FGFs) of 1 L min -1 , 360 L of oxygen would be consumed. Zhong and colleagues recommendation of a FGF of 6 L min -1 would increase the oxygen consumption to 2160 L. Higher flows may be used for induction and emergence with both modes of anaesthesia, thus allowing a fair comparison. Within the confines of safety, improving cost efficiency and environmental burdens must be a priority. 6 Given the current shortage of the most precious of medical resources in many countries across the world, we feel the 'high-flow' anaesthesia suggested here would be best left until after this pandemic has abated.

The authors declare that they have no conflicts of interest.

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