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AGC technology permits safe and convenient reduction of anesthetic waste by up to 58% [1]

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Operating Room
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Operating Room
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Sevoflurane consumption in manual vs automatic gas control

Both ecological and economic considerations dictate minimizing wastage of volatile anesthetics. To reconcile apparent opposing stakes between ecological/ economical concerns and stability of anesthetic delivery, new workstations feature automated software that continually optimizes the Fresh Gas Flow (FGF) to reliably obtain the requested gas mixture with minimal volatile anesthetic waste. The aim of this study is to analyze the kinetics and consumption pattern of different approaches of sevoflurane delivery with the same 2% end-tidal goal in all patients. The consumption patterns of sevoflurane of a Flow-i were retrospectively studied in cases with a target end-tidal sevoflurane concentration (Etsevo) of 2%. For each setting, 25 cases were included in the analysis. In Automatic Gas Control (AGC) V4.4, a speed setting 6 was observed, with software V4.7, speed settings 2 were observed, and a group with a fixed 2 L/min FGF. In 45 min, an average of 14.5 mL was consumed in the 2L-FGF group, 7.1 mL in the AGC4.4 group and 6.0 mL in the AGC4.7 group. The more recent AGC4.7 algorithm was more efficient than the older AGC4.4 algorithm. This study indicates that the AGC technology permits very significant economic and ecological benefits, combined with excellent stability and convenience, over conventional FGF settings and should be favoured. Routine clinical practice using what historically is called “low flow anesthesia” (e.g. 2 L/min FGF) should be abandoned, and all anesthesia machines should be upgraded as soon as possible with automatic delivery technology to minimize atmospheric pollution with volatile anesthetics.

This study indicates that the AGC technology permits very significant economic and ecological benefits, combined with excellent stability and convenience, over conventional FGF settings and should be favoured. Routine clinical practice using what historically is called “low flow anesthesia” (e.g. 2 L/min FGF) should be abandoned, and all anesthesia machines should be upgraded as soon as possible with automatic delivery technology to minimize atmospheric pollution with volatile anesthetics.

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The products, availability of the Flow Family anesthesia systems and SW version may be pending regulatory approvals to be marketed in your country. Contact your Getinge representative for more information. The assertions stated by the physician are strictly those of the physician and do not necessarily reflect the views of Getinge.
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  1. 1. Kalmar AF, Van Der Vekens N, De Rydt F, Allaert S, Van De Velde M, Mulier J. Minimizing sevoflurane wastage by sensible use of automated gas control technology in the flow-i workstation: an economic and ecological assessment. J Clin Monit Comput. 2022 Jan 3. doi: 10.1007/s10877-021-00803-z. Epub ahead of print. Erratum in: J Clin Monit Comput. 2022 Feb 14;: PMID: 34978655.