From Sally Rampersad, MB, FRCA, Attending Anesthesiologist and Professor Dept of Anesthesiology and Pain Medicine Seattle Children's Hospital and University of Washington School of Medicine
I am the lead anesthesiologist for oncology procedures at Seattle Children’s. Our current guidelines for oncology procedures are:
Bone marrow aspirate/biopsy – any platelet count is OK (you can press on it!)
Lumbar puncture - >20K (patients will get a pre-procedure transfusion to reach that threshold if needed)
Lumbar puncture in new diagnosis patient - >50K (because contamination of the CSF sample with blood alters their risk stratification and affects the next three years of their life potentially).
From Éireann Allen MB BCh BAO BSc FRCA FFPMR, Paediatric Anaesthesia Fellow @ SickKids, Toronto on gas scavenging in ICU ventilators
There are many companies in Europe manufacturing these products. They are in line within the circle system and cannisters are collected by the company to extract volatile after use. One issue in the environmental impact of having to transport en bulk back to their centres in Europe at the moment but that work and no doubt the technology will improve with time. The Scottish Health Technology group has posted the following PDF. https://shtg.scot/media/2470/20240529-vct-recommendation-v10.pdf
My (Myron) read of the PDF sent to me by Dr. Allen is that the Scottish Health Technology group does not recommend routine widespread use of this technology at the present time.
Dr Jeff Feldman is working on a more thorough look at this technology for the PAAD community that will be posted on September 30.
Additionally, here is another article and image to consider reading on gas capture and recycling in the OR.
image from Müller-Wirtz LM, Volk T, Meiser A. Towards sustainability of volatile anaesthetics: capture and beyond. Br J Anaesth. 2024 Dec;133(6):1363-1366. doi: 10.1016/j.bja.2024.08.022. Epub 2024 Oct 4. PMID: 39551551.