Honors Theses and Capstones

Date Completed

Spring 2026

Abstract

Volatile anesthetic gases contribute significantly to healthcare-related greenhouse gas emissions. These greenhouse gas emissions can be increased due to higher fresh gas flows. At Dartmouth-Hitchcock Medical Center (DHMC), open and semi-open systems with fresh gas flow (FGF) rates above two liters per minute result in anesthetic gas waste. Literature suggests multifaceted quality improvement interventions are effective in improving low fresh gas flow adherence in anesthesia provider practices. The purpose of this study was to evaluate the potential reduction in anesthetic gas waste and carbon dioxide equivalent (CO₂e) emissions at Dartmouth-Hitchcock Medical Center through improved adherence to low fresh gas flow anesthesia practices.

Fresh gas flow adherence data from anesthesia cases between 2021 and 2025 were analyzed to estimate anesthetic gas waste and greenhouse gas emissions. Waste calculations incorporated provider compliance with FGF ≤2 L/min, published rebreathing estimates for low-flow anesthesia, anesthetic gas densities, and global warming potentials for nitrous oxide, sevoflurane, and isoflurane. Results showed that implementation of a 1 L/min FGF threshold instead of the DHMC baseline of  2 L/min could have reduced anesthetic greenhouse gas emissions by an estimated 13,574,645.51 kg CO₂e over the five-year study period.

Literature demonstrates that successful QI initiatives across institutions demonstrate that low FGF adoption is both feasible and impactful when supported by targeted, multifaceted interventions such as provider education, EMR-integrated alerts, Behavioral encouragements, and system-level changes. These findings show that DHMC could reduce their anesthic gas waste while maintaining patient safety.

Document Type

Undergraduate Thesis

First Advisor

Alyssa O'Brien

College or School

CHHS

Department or Program

Nursing

Degree Name

Bachelor of Science

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