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Canadian Journal of Anesthesia

, Volume 51, Issue 9, pp 892–898 | Cite as

Under “real world” conditions, desflurane increases drug cost without speeding discharge after short ambulatory anesthesia compared to isoflurane

  • Stephan K. W. Schwarz
  • Noam N. Butterfield
  • Bernard A. MacLeod
  • Edward Y. Kim
  • Luigi G. Franciosi
  • Craig R. Ries
General Anesthesia

Abstract

Purpose

To compare the measured “real world” perioperative drug cost and recovery associated with desflurane- and isoflurane-based anesthesia in short (less than one hour) ambulatory surgery.

Methods

We conducted a prospective, randomized, blinded trial with patients undergoing arthroscopic meniscectomy under general anesthesia. Followingiv induction, patients received either isoflurane (group I;n = 25) or desflurane (group D;n = 20) for maintenance. The primary outcome variable was total perioperative drug cost per patient in Canadian dollars. Secondary outcome variables included volatile agent consumption and cost, adjuvant anesthetic and postanesthesia care unit (PACU) drug cost, readiness for PACU discharge, and incidence of adverse events.

Results

Total perioperative drug cost per patient was $14.58 ± 6.83 (mean ± standard deviation) for group I, and $21.47 ± 5.18 for group D (P < 0.001). Isoflurane consumption per patient was 6.0 ± 3.0 mL compared to 18.6 ± 7.7 mL for desflurane (P < 0.0001); corresponding costs were $0.83 ± 0.42vs $7.61 ± 3.15 (P < 0.0001). There were no differences in adjuvant anesthetic or PACU drug cost. All but one patient from each group were deemed ready for PACU discharge at 15 min postoperatively (Aldrete score ≥ 9). One patient in group D experienced postoperative nausea. No other adverse events were noted.

Conclusions

Measured total perioperative drug cost for a short ambulatory procedure (less than one hour) under general anesthesia was higher when desflurane rather than isoflurane was used for maintenance, essentially due to volatile agent cost. Desflurane use did not translate into faster PACU discharge under “real world” conditions.

Keywords

Isoflurane Sevoflurane Drug Cost Mean Arterial Blood Pressure Laryngeal Mask Airway 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Dans les conditions du «monde réel», le desflurane augmente le coût des médicaments sans hâter le départ après une anesthésie ambulatoire de courte durée comparé à l’isoflurane

Résumé

Objectif

Comparer le coût des médicaments périopératoires, mesuré dans des conditions réelles, et la récupération associée à l’anesthésie avec desflurane, et isoflurane, pour la chirurgie ambulatoire de courte durée (moins d’une heure).

Méthode

Notre étude prospective, randomisée et à l’insu a été menée auprès de patients devant subir une méniscectomie arthroscopique sous anesthésie générale. Après l’induction iv, l’anesthésie a été maintenue avec de l’isoflurane (groupe I; n = 25) ou du desflurane (groupe D; n = 20). Le coût total des médicaments périopératoires par patient a été mesuré en dollars canadiens. La consommation d’anesthésique volatil et leur coût, le coût des anesthésiques adjuvants et des médicaments utilisés en salle de réveil (SDR), la capacité à quitter la SDR et l’incidence d’événements indésirables ont été notés.

Résultats

Le coût total des médicaments par patient a été de 14,58 ± 6,83 $ (moyenne ± écart type) pour le groupe I et de 21,47 ± 5,18 $ pour le groupe D (P < 0,001). La consommation d’isoflurane par patient a été de 6,0 ±3,0 mL, comparée à 18,6 ± 7,7 mL pour le desflurane (P < 0,0001); les coûts correspondants ont été de 0,83 ± 0,42 $ vs 7,61 ± 3,15 $ (P < 0,0001). Le coût des anesthésiques adjuvants et des médicaments en SDR était comparable. Tous les patients, sauf un de chaque groupe, ont été jugés prêts à quitter la SDR 15 min après l’opération (score d’Aldrete = 9). Un patient du groupe D a eu des nausées postopératoires. Aucun événement indésirable n’a été noté.

Conclusion

Le coût total des médicaments périopératoires en chirurgie ambulatoire de courte durée (moins d’une heure), sous anesthésie générale, a été plus élevé avec le desflurane, comparé à l’isoflurane, pour maintenir l’anesthésie, essentiellement à cause du coût de l’agent volatil. L’usage de desflurane ne se traduit pas par un départ plus rapide de la SDR dans les conditions du «monde réel».

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  • Stephan K. W. Schwarz
    • 1
  • Noam N. Butterfield
    • 1
  • Bernard A. MacLeod
    • 1
  • Edward Y. Kim
    • 1
  • Luigi G. Franciosi
    • 1
  • Craig R. Ries
    • 1
  1. 1.Centre for Anesthesia and Analgesia, Departments of Anesthesia and Pharmacology TherapeuticsThe University of British ColumbiaVancouverCanada

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