Current practice of gas scavenging in pediatric anesthesia in Belgium: results of a nationwide questionnaire survey.

Background and Goal of the Study
Traditionally, an open breathing system without gas scavenging is used for induction with volatile agents in pediatric patients. 
However, multiple adverse health outcomes are linked to occupational exposure to waste anesthetic gases (WAG). As a consequence, WAG scavenging has gained importance and it is advised to take measurements of WAG concentrations (WAGC) in the operating room (OR).
Hence, the aim of this survey was to investigate the application of gas scavenging during mask induction in pediatric anesthesia and the practice of WAGC measurement.

Material and Methods 
In May 2015, the chairmen of all 94 Belgian departments of anesthesiology were invited by email to participate in a web-survey. After 4 reminders, the remaining non-responders received an identical written questionnaire by post. Descriptive statistics were used to summarize numeric responses. 
A chi-square test for independence was performed to test for possible association between use of gas scavenging (yes vs no) during induction of children aged 1 – 4 yr. and implementation of WAGC measurement (yes vs no) in the OR.

Results and discussion
From May 2015 to October 2015, 71 departments responded (76%). Children aged < 1 yr. were operated in 68 of 71 responding hospitals and above 1 year old in all responding hospitals. 
Gas scavenging during mask induction in children aged < 1 yr. was applied in only 34 of 68 departments (50%). During induction in children aged 1 - 4 yr. and > 4 yr., respectively 41 (57,7%) and 49 (69%) of 71 responding departments applied gas scavenging. 
The past 5 years, WAGC measurements were taken in 18 departments, in 46 none were taken and in 7 data were missing. After exclusion of departments with missing data, an association could be shown between the use of gas scavenging during mask induction and implementation of WAGC measurement at a significance level of α = .05 (for children aged 1 - 4 yr: X2 = 4.716 ; p = 0.0298). 

Conclusion
The application of gas scavenging during mask induction in pediatric anesthesia is rather infrequent in Belgian hospitals and is proportional to age of the patient (lowest in children aged < 1yr). 
Furthermore, we found a strong association between the use of gas scavenging during mask induction and implementation of WAGC measurement in the OR. This implies that implementation of WAGC measurement in the OR should be obligatory in all hospitals in an attempt to reduce occupational exposure to WAG.

Current practice of gas scavenging in paediatric anesthesia in Belgium: results of a nationwide questionnaire survey