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BACKGROUND: End-tidal target-controlled inhalational anaesthesia (TCIA) with halogenated agents (HA) provides a faster and more accurately titrated anaesthesia as compared to manually-controlled anaesthesia. This study aimed to measure the macro-economic cost-benefit ratio of TCIA as compared to manually-controlled anaesthesia. METHODS: This retrospective and descriptive study compared direct drug spending between two hospitals before 2011 and then after the replacement of three of six anaesthesia machines with TCIA mode machines in 2012 (Aisys carestation®, GE). The direct costs were obtained from the pharmacy department and the number and duration of the anaesthesia procedures from the computerized files of the hospital. RESULTS: The cost of halogenated agents was reduced in the hospital equipped with an Aisys carestation® by 13% as was the cost of one minute of anaesthesia by inhalation (€0.138 and €0.121/min between 2011 and 2012). The extra cost of the implementation of the 3 anaesthesia machines could be paid off with the resulting savings over 6 years. DISCUSSION: TCIA appears to have a favourable cost-benefit ratio. Despite a number of factors, which would tend to minimise the saving and increase costs, we still managed to observe a 13% savings. Shorter duration of surgery, type of induction as well as the way HA concentration is targeted may influence the savings results obtained.

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BACKGROUND: Reducing fresh gas flow (FGF) during general anesthesia reduces costs by decreasing the consumption of volatile anesthetics and attenuates their contribution to greenhouse gas pollution of the environment. The sevoflurane FGF recommendations in the Food and Drug Administration package insert relate to concern over potential toxicity from accumulation in the breathing circuit of compound A, a by-product of the reaction of the volatile agent with legacy carbon dioxide absorbents containing strong alkali such as sodium or potassium hydroxide. Newer, nonreactive absorbents do not produce compound A, making such restrictions moot. We evaluated 4 hypotheses for sevoflurane comparing intervals before and after converting from a legacy absorbent (soda lime) to a nonreactive absorbent (Litholyme): (1) intraoperative FGF would be reduced; (2) sevoflurane consumption per minute of volatile agent administration would be reduced; (3) cost savings due to reduced sevoflurane consumption would (modestly) exceed the incremental cost of the premium absorbent; and (4) residual wastage in discarded sevoflurane bottles would be <1%. METHODS: Inspired carbon dioxide (PICO2), expired carbon dioxide, oxygen, air, and nitrous oxide FGF, inspired volatile agent concentrations (FiAgent), and liquid volatile agent consumption were extracted from our anesthesia information management system for 8 4 week intervals before and after the absorbent conversion. Anesthesia providers were notified by e-mail and announcements at Grand Rounds about the impending change and were encouraged to reduce their average intraoperative sevoflurane FGF to 1.25 L/min. Personalized e-mail reports were sent every 4 weeks throughout the study period regarding the average intraoperative FGF (i.e., from surgery begin to surgery end) for each agent. Batch means methods were used to compare FGF, volatile agent consumption, net cost savings, and residual sevoflurane left in bottles to be discarded in the trash after filling vaporizers. The time from reaching a PICO2 = 3 mm Hg for 3 minutes until agent exhaustion (PICO2 = 5 mm Hg for 5 minutes) was evaluated. RESULTS: A total of N = 20,235 cases were analyzed (80.2% sevoflurane, 15.1% desflurane, and 4.7% isoflurane). Intraoperative FGF was reduced for cases in which sevoflurane was administered by 435 mL/min (95% confidence interval [CI], 391 to 479 mL/min; P < 10). Hypothesis 1 was accepted. Sevoflurane consumption per minute of administration decreased by 0.039 mL/min (95% CI, 0.029 to 0.049 mL/min; P < 10) after the change to the nonreactive absorbent. Hypothesis 2 was accepted. The difference in mean cost for the sum of the sevoflurane and absorbent purchases for each of the 10 4-week intervals before and after the absorbent switch was -$293 per 4-week interval (95% CI, -$2853 to $2266; P = 0.81). Hypothesis 3 was rejected. The average amount of residual sevoflurane per bottle was 0.67 ± 0.06 mL (95% CI, 0.54 to 0.81 mL per bottle; P < 10 vs 2.5 mL). Hypothesis 4 was accepted. Once the PICO2 reached 3 mm Hg for at least 3 consecutive minutes, the absorbent became exhausted within 95 minutes in most (i.e., >50%) canisters. CONCLUSIONS: We showed that an anesthesia department can transition to a premium, nonreactive carbon dioxide absorbent in a manner that is at least cost neutral by reducing FGF below the lower flow limits recommended in the sevoflurane package insert. This was achieved, in part, by electronically monitoring PICO2, automatically notifying the anesthesia technicians when to change the absorbent, and by providing personalized feedback via e-mail to the anesthesia providers.

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Flocculation of microalgae with chitosan, polyacrylamide, Al2(SO4)3, NaOH and HNO3 was evaluated. Their flocculation efficiencies and optimal dosages were discussed. The effects of the flocculants on cells viability were also investigated and the cells were found to be intact during the flocculation process. Moreover, the effects of flocculants on the extractions were evaluated. Lipid content after flocculants treatments showed no significant differences. Carbohydrate content was lower but protein content was higher after NaOH treatment than those after other treatments. Furthermore, the five flocculated media maintained approximate growth yields to that of the fresh medium in microalgal cultivation, indicating the five flocculated media could be recycled, thereby reducing the cost of biodiesel production from microalgae. Finally, economic comparison of the flocculants was made and the cost of using HNO3, including flocculating cells and recycling medium, was found to be the lowest.

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In this investigation, an effort was made to pretreat surplus waste activated sludge (WAS) inexpensively by a novel combined process involving thermo chemical disperser pretreatment. This pretreatment was found to be efficient at a specific energy (SE) consumption of 3360.94 kJ/kg TS, with the chemical oxygen demand (COD) solubilization of 20%. This was comparatively higher than thermo chemically treated sludge where the solubilization was found to be 15.5% at a specific energy consumption of 10,330 kJ/kg TS respectively. Higher production of volatile fatty acids (VFA) (675 mg/L) in anaerobic fermentation of pretreated WAS indicates better hydrolysis performance. The biogas production potential of sludge pretreated through this combined technique was found to be 0.455 (L/gVS) and comparatively higher than thermo chemically pretreated sludge. Economic investigation provides 90% net energy savings in this combined pretreatment. Therefore, this combined process was considered to be potentially effective and economical in sludge disintegration.

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In contrast to conventional carbon capture systems for power plants and other large point sources, the system described in this paper captures CO2 directly from ambient air. This has the advantages that emissions from diffuse sources and past emissions may be captured. The objective of this research is to determine the feasibility of a NaOH spray-based contactor for use in an air capture system by estimating the cost and energy requirements per unit CO2 captured. A prototype system is constructed and tested to measure CO2 absorption, energy use, and evaporative water loss and compared with theoretical predictions. A numerical model of drop collision and coalescence is used to estimate operating parameters for a full-scale system, and the cost of operating the system per unit CO2 captured is estimated. The analysis indicates that CO2 capture from air for climate change mitigation is technically feasible using off-the-shelf technology. Drop coalescence significantly decreases the CO2 absorption efficiency; however, fan and pump energy requirements are manageable. Water loss is significant (20 mol H2O/mol CO2 at 15 degrees C and 65% RH) but can be lowered by appropriately designing and operating the system. The cost of CO2 capture using NaOH spray (excluding solution recovery and CO2 sequestration, which may be comparable) in the full-scale system is 96 $/ton-CO2 in the base case, and ranges from 53 to 127 $/ton-CO2 under alternate operating parameters and assumptions regarding capital costs and mass transfer rate. The low end of the cost range is reached by a spray with 50 microm mean drop diameter, which is achievable with commercially available spray nozzles.

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The utilisation time of carbon dioxide absorbers in anaesthesia textbooks is nearly identically specified to last about 5 hours. Therefore in most departments the soda lime of the absorbers is changed routinely on a daily schedule. As rebreathing volume increases considerably with fresh gas flow reduction, the question arises as to whether the soda lime should be changed at even shorter intervals--if low-flow anaesthesia is performed routinely--to to guarantee carbon dioxide absorption safely. In three anaesthesia machines with different technical properties the carbon dioxide absorbers were only changed when the inspiratory carbon dioxide concentration increased to 1 vol. %, indicating definite exhaustion of the soda lime. If a fresh gas flow of 4.4 l/min was used exclusively, utilisation times of 42.7 and 62.3 hours were measured using absorbers filled with 1 l of soda lime pellets, whereas a utilisation time of 98.7 hours was noted with a 1.5 l absorber, all values being surprisingly higher than the above-mentioned figure. If, however, minimal flow anaesthesia is performed routinely in clinical practice, the percentage of time in which the fresh gas flow can really be reduced to 0.5 l/min does not exceed 50 to 80%. Under these conditions the utilisation time of the absorbers decreases to between one half (1/2) and one quarter (1/4) of the utilisation time which can be gained if a flow of 4.4 l/min is used. Thus, the performance of minimal-flow anaesthesia increases the consumption of soda lime two- to fourfold.(ABSTRACT TRUNCATED AT 250 WORDS)

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