Study Evaluates Propofol Wastage Reduction Strategies in Total Intravenous Anesthesia

Climate change is a serious public health issue and hence new strategies have to be developed for sustainable healthcare practices. Among the hospitals, Anesthesia and intensive care are noted for high resource and energy consumption contributing heavily to hospital waste. Hence, Associations like the Association of Anaesthetists of Great Britain and Ireland and the German Society for Anaesthesiology have recommended reducing carbon dioxide emissions from hospitals. Medications like propofol which are commonly used anesthetic agents significantly contribute to medication waste from the hospitals. Total intravenous anesthesia (TIVA) uses both induction and maintenance of anesthesia by using propofol. Maintenance of TIVA is commonly achieved using an automated syringe pump, whereas induction is achieved either manually using a separate syringe or by programming a bolus through the syringe pump. Hence, current protocols suggest using smaller vials and prediction tools to reduce the wastage of propofol in hospital settings. As there is limited data on effective methods of using these, researchers conducted a retrospective study to investigate the amount of propofol wastage using either of the induction methods.

A retrospective analysis was carried out by including adult patients (≥18 years) undergoing TIVA at the University Hospital Bonn. Data was collected on the complete anesthetic and waste documentation from both paper and electronic anesthesia records by recording anesthetic duration, patient characteristics, substance use, and propofol administered. Induction was done with a separate syringe for manual induction or by a bolus programmed on an automated syringe pump for induction and maintenance. The primary endpoint was total propofol waste during surgery including the unused amounts in the syringe and pump.

Results:

• Syringe pump induction was associated with 32.8% less waste of propofol (P<0.001) than manual method.
• This reduction was most pronounced in procedures lasting 20–60 min (up to 46.9% less in procedures lasting 20–40 min, P<0.001) and 80–120 min (up to 48.8% less in procedures lasting 100–120 min, P=0.003).
• Variables like biological sex, age, weight, BMI, or ASA physical status did not affect the amount of wastage.
• Syringe pump induction was consistently associated with less waste, except in patients with obesity.
• Patients with active substance use had 27.6% more waste with manual induction (P=0.031) but not with syringe pump induction.
• In patients with and without active substance use, syringe pump induction resulted in less waste (substance use: 48.7% less, P=0.0015; without substance use: 22.7% less, P=0.0045).

Thus, the study concluded that Syringe pump induction reduced propofol waste during TIVA, regardless of patient characteristics. This method could be a more sustainable, cost-effective method considering the impact of manual induction on the environment.

Further reading: Windler F, Coburn M, Bette B, Fingerhut D, Jacobi A, Kruse P. Effects of manual and syringe pump induction of total intravenous anaesthesia on propofol waste: a single-centre retrospective analysis. Br J Anaesth. Published online October 28, 2024. doi:10.1016/j.bja.2024.10.002