A Qualitative Study of the Practice Preferences for Low and Minimal Fresh Gas Flow Anesthesia Using In-Depth Interviews
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Abstract
Objectives: This study primarily aimed to explore the preferences of anesthesia personnel for low (0.5–1.0 L·min−1) and minimal (< 0.5 L·min−1) fresh gas flow (FGF) techniques. The secondary objective was to identify factors influencing their decision-making.
Materials and Methods: After ethics approval, data were collected through in-depth interviews and nonparticipant observation over a 2-month period—from December 2022 to January 2023. This study included four anesthesiologists and six nurse anesthetists.
Results: All participants were females, and 30% were aged 31–40 years. Moreover, 40% had < 5 years of experience in anesthesiology. The duration of clinical practice ranged from 3 months to 28 years (median and mean of 6 years and 10.7 years, respectively). Additionally, 60% were not permanently assigned to a specific anesthesia service. Regarding FGF, 50% used 1.0–1.5 L·min−1, only 30% used 0.5–1.0 L·min−1, and none used < 500 mL·min−1. Five key factors influenced decision-making: personal factors (clinical knowledge and previous hand-on experience), equipment factors (appropriate equipment and monitoring support), patient factors (patient safety concerns and characteristics of the individual patient), institutional factors (practices, policies, and norms of the department), and environmental awareness factor (climate concern).
Conclusion: Low and minimal FGF anesthesia are not yet widely favored by anesthetic personnel in Vajira Hospital. This study shows that the routine use of low and minimal FGF anesthetic technique is influenced by various factors. Although knowledge and hands-on experience are crucial, decisions are also influenced by opinions of coworkers, hospital policies, standard practices, availability of monitoring and equipment, and healthcare financing models such as impact of fix-payment system. All of the abovementioned pose significant barriers to promote the safe and sustainable use of low and minimal FGF techniques.
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