Want to save a few dollars when patients drift away to dreamland? Here are five quick and easy ways to cut your anesthesia costs right now.

Turn off the oxygen when the patient is disconnected from it.
Everyone agrees it's the anesthesia team's responsibility to turn off the oxygen on the anesthesia machine at the end of each case and at the end of each day. And it's the PACU nurse's obligation to shut off the oxygen when the patient departs.

The bottom line? It's not happening. Go look. You've probably got an anesthesia machine streaming oxygen into an empty OR right now. Yes, oxygen isn't a big-ticket item, but wasted oxygen burns your bottom line even as it increases the risk of fire in your OR.

Oxygen tanks supplying freestanding facilities typically hold nearly 14,000 liters of gas, which costs around $80, depending on the supplier. Oxygen left flowing at 5 liters/ minute on Friday will empty a tank by Monday. It happens. A surgery center had an anesthesia machine left on, with the oxygen flowing, one Friday afternoon when the lights were turned out. The result: Monday's cases were delayed until the medical gas supplier arrived to refill the empty tanks. Not only did the bucks spent on that oxygen vaporize into thin air, but the patients and surgeons were none too happy, as you might expect.

Wasted oxygen will cause sticker shock when it escapes with one of your inhalation agents. It's not unheard of for an anesthetist to arrive for a morning case and find the sevoflurane (Ultane) vaporizer on, open and bone dry - with the oxygen still gushing. A bottle of sevoflurane to fill that vaporizer can cost $100 or more. Now that's not pocket change. And again, aside from the costs associated with wasted oxygen and depleted anesthetic agents, an OR enriched with oxygen is inviting a flaming fire. Here's a quick solution worth trying: Designate one person and one backup to verify that each anesthesia machine's flowmeter and the vaporizers are off at the end of the day and that all oxygen outlets in PACU are off.

Spread the word when you shift a case from one OR to another.
To speed turnover whenever possible, anesthetists prepare for the next case even as the current one is in progress. Inform both affected providers directly as soon as you make the decision to move the case. The result: You reduce the waste of two sets of anesthesia supplies set up for one patient. That means less unused drugs squirted down the sink and fewer endotracheal tubes tossed in the wastebasket. Anesthesia supplies already prepared for the case can be passed across the hall by the circulator to the receiving anesthetist.

Granted, some providers won't be comfortable using supplies prepared by another anesthetist, but where anesthesia teams work closely and frequently together, trust builds, and this usually works. Obviously you don't want to violate any policy your center may have on opened supplies or drugs, but at the very least telling the providers you're transferring a case saves time and reduces stress.

Tear up your one-for-all protocols.
Just because a patient puts on a gown and sits on a stretcher doesn't mean he needs a gram of the antibiotic du jour or a dose of an antiemetic. Administering antibiotics, antiemetics or aspiration prophylaxis to every patient is expensive and unnecessary.

Take, for example, the 65-year-old male with no history of reflux having local anesthesia with a scant amount of propofol sedation for excision of basal cell carcinoma excision on his nose. It's unlikely that this patient will benefit from a complete aspiration prophylaxis because he isn't a high-risk candidate for PONV or aspiration in the first place. The surgeon, based on the patient's condition and the proposed procedure, should determine the need for antibiotic prophylaxis. The need for aspiration prophylaxis or antiemetics should be in the hands of the anesthesia provider based on individual patient need.

Stop ordering individually wrapped sterile tongue blades.
Because we're putting these tongue blades into the human mouth, they don't need to be sterile. Besides, it's time-consuming to unwrap these individually sealed tongue blades. It's not big bucks you're saving here, but pocket change adds up to folding money over time.

Order some droperidol and dexamethasone.
Droperidol (Inapsine) fell from favor a few years ago after the FDA, for reasons that perplex countless healthcare professionals, issued a "black box" warning. The bone of contention is a suspected link between droperidol and cardiac arrhythmias, specifically, the grave torsades de pointes. Yet many anesthetists who've been using droperidol off-label as an ambulatory patient antiemetic in low doses (.25cc to .50cc) would say that they've never had a problem with droperidol.

"Inapsine is as safe as many of the other antiemetics we commonly use," says Thomas Cutter, MD, of the department of anesthesia and critical care at the University of Chicago Pritzker School of Medicine. "It got a bum rap over a few isolated cases."

Why bother with droperidol and dexamethasone? Because both have years of proven economical efficacy for preventing PONV. And in patients in whom it's appropriate, it can be a good choice. Droperidol costs about $1.25 for a 2cc amp; the newer 5HT3 (serotonin) antagonist drugs can be significantly more expensive. If droperidol is off your formulary, it may be worth reviewing the literature related to its use and reconsidering it for your facility. OSM