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