Target-controlled inhalation anaesthesia: A cost-benefit analysis based on the cost per minute of anaesthesia by inhalation (original) (raw)
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Evaluation of cost minimization strategies of anaesthetic drugs in a tertiary care hospital
Canadian Journal of Anaesthesia, 1994
A survey was undertaken to compare anaesthetic drug expenditures over a three-year period, to evaluate the impact of strategies offered to curtain continuously rising drug costs. Suggestions to control rising expenditures were based primarily on education of staff and residents regarding drug costs, empha-" sizing rational use of the more expensive drugs, and minimizing drug wastage. To assess the impact of these measures, a review of annual hospital budgets, global pharmacy expenditures, and anaesthetic drug expenditures was conducted for the period 1991 to 1993. Both absolute and proportional costs of anaesthetic drugs were compared, by year, according to six major classes: opioid analgesics (OA), muscle relaxants (MR), inhalational anaesthetic drugs (INH), intravenous anaesthetic drugs (IV), local anaesthetic drugs (LA) and a category labdled other drugs (OTH). In addition, the utilization patterns and unit price changes were compared for each drug for the periods 1991-92, and 1992-93.
Low flow and economics of inhalational anaesthesia
Best Practice & Research Clinical Anaesthesiology, 2005
Even when anaesthesia does not represent a major part of the expense of a given surgical operation, reducing costs is not negligible because the large number of patients passing through a department of anaesthesia accounts for a huge annual budget. Volatile anaesthetics contribute 20% of the drug expenses in anaesthesia, coming just behind the myorelaxants; however, the cost of halogenated agents has potential for savings because a significant part of the delivered amount is wasted when a non-or partial-rebreathing system is used. The cost of inhaled agents is related to more than the amount taken up; it also depends on their market prices, their relative potencies, the amount of vapour released per millilitre of liquid, and last but not least the freshgas flow rate (FGF) delivered to the vaporizer-the most important factor determining the cost of anaesthesia. Poorly soluble agents like desflurane and sevoflurane facilitate the control of lowflow anaesthesia and reduce the duration of temporary high-flow phases to rapidly wash in or adjust the circuit gas concentrations. Modelling low-flow or minimal-flow anaesthesia will help anaesthetists to understand the kinetics of inhaled agents in those circumstances and to design their own clinical protocols. The monitoring facilities present on modern anaesthesia machines should convince clinicians that low-or even minimal-flow anaesthesia would not jeopardize the safety of their patients. Cost containment requires primarily a decrease in FGFs, but it may also be influenced by a rational use of the available halogenated agents. Isoflurane, the cheapest generic agent, might be advantageous for maintenance of anaesthesia of less than 3 hours. Sevoflurane is the agent of choice for inhalational induction and might also be used for maintenance. Desflurane might be preferred for long anaesthetics where rapid recovery will generate savings in the PACU.
A survey of 112,000 anaesthetics at one teaching hospital (1975–83)
Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1986
This paper describes the outcome of a nine-year post-anaesthetic followup program in a large teaching hospital (N = 112,721 anaesthetics). Between time periods 1975-78 and 1979-83, more seriously ill patients (higher ASA physical status) were being treated. Anaesthetic practice also changed, with an increased use of balanced (multiple drug) anaesthetic procedures, a decrease in the use of halothane and an increase in the use of monitoring. Nonfatal anaesthetic complications — intraoperative, recovery room and postoperative — were rare but there was an increase in the reported complication rate over time. From 1975-78, 7.6per cent of all cases had at least one intraoperative complication and from 1979-83, this rose to 10.6 per cent of all cases. For recovery room complications, there was an increase to5.9 per cent in 1979-83 from 3.1 per cent in 1975-78. In time period 2 there was a 9.4 per cent chance of having a postoperative anaesthetic-related complication, and a 0.45 per cent chance of a significant morbidity as a result. This represents an increase over time period 1 (8.9 and 0.40 per cent respectively). It is concluded that the anaesthetic experience, while associated with low mortality rates in recent years, is still associated with significant morbidity. It is conjectural at present whether this is refiective of preoperative patient status, anaesthetic practice, or other undefined variables associated with an operative experience. Ce papier expose les résultats de neuf ans d’étude d’un programme de suivie post-anesthésique dans un grand hôpital universitaire (N = 112,721 anesthésies). Pour les périodes de 1975-78 et 1979-83 plus de patients sérieusement malades (classe ASA plus élevés) ont été traités. La pratique anesthésique a aussi changé avec un accroissement dans l’utilisation d’une anesthésie balançée (l’utilisation de plusieurs drogues) la diminution dans l’utilisation de l’halothane et une augmentation dans l’utilisation des moniteurs physiologiques. Les complications anesthésiques non léthales pour les périodes per-opératoire, en salle de réveil et en période post-opératoire étaient rares. Cependant on a observé un accroissement dans le taux de complications rapporté à travers le temps. Pour la période de 1975-78, une complication per-opératoire a été rapportée pour 7,6 pour cent des cas. De 1979-83, ce pourcentage augmenta à 10.6 pour cent. Pour les complications survenant à la salle de réveil on observa un accroissement de 5.9 pour cent en 1979-83 à partir de 3.1 pour cent en 1975-78. Dans la deuxième période étudiée le risque d’avoir des complications post-opératoire reliées à l’anesthésie était de 9.4 pour cent avec 0.45 pour cent de risque d’avoir une morbidité significative. Ceci représente un accroissement par rapport à la première période de 8.9 et 0.40 pour cent respectivement. On conclut que l’expérience anesthésique même si elle est associée avec un taux de mortalité bas dans les dernières années reste pour le moins encore associée avec une morbidité significative. Il est hypothétique actuellement de penser que ceci peut être le reflet de l’état pré-opératoire du patient, de la pratique anesthésique ou tout autre variable indéfinie associée avec une expérience chiruricale.
Srpski arhiv za celokupno lekarstvo, 2010
Introduction. In anaesthesiology, economic aspects have been insufficiently studied. Objective. The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. Methods. The costs of anaesthesiological services were counted based on ?unit? prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student?s t-test and ?2-test. Results. The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p=0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (?2-test, p=0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some...
European Journal of Anaesthesiology, 2001
We evaluated the costs and benefits of total intravenous anaesthesia compared with a balanced anaesthesia regimen. One-hundred and twenty-four patients undergoing cataract surgery were randomized to either a propofol/remifentanil or an isoflurane/fentanyl group. In the propofol/remifentanil group, both drugs were used for induction and maintenance of anaesthesia; in the isoflurane/fentanyl group, anaesthesia was induced with etomidate and fentanyl and maintained with isoflurane and fentanyl. All patients received mivacurium for muscle relaxation and the lungs were ventilated mechanically. The use of propofol and remifentanil resulted in a faster emergence and an overall savings per case of [symbol: see text] 12.25 due to a reduction in personnel costs which outweighs the higher drug acquisition costs. In the propofol and remifentanil group, more patients were satisfied and would accept the same anaesthetic again. We conclude that propofol and remifentanil is more cost-effective than isoflurane/fentanyl due to its better recovery profile, reduced total direct costs and higher patient satisfaction.
Anesthesiology Clinics, 2009
Most financial analysis regarding the cost of non-operating room (non-OR) anesthesia in hospitals is incorrect. This statement is strong, but this article indicates why this situation exists and suggests how to perform the cost analysis in the right way. It also reviews financial and operational strategies that can result in more efficient scheduling of anesthesia, thereby freeing up anesthesiologist time in the main OR for non-OR needs.
Possibilities of Anesthesia Cost Management by Analysis of Different Anesthesiology Techniques
The must of material cost rationalization in medical practice has stimulated the authors to analyze the structure of material expenses of spinal and general anesthesia on a model of arthroscopic knee surgery. The aim was to determine whether the cost of spinal anesthesia was still lower than that of general anesthesia after the introduction of expensive atraumatic needles. In addition, we were interested in the extent to which our daily practice correlated with that in industrialized countries and what were the possibilities of cost rationalization. Using retrograde analysis of two comparable groups of 40 patients each, submitted to arthroscopic knee surgery in general or spinal anesthesia, the anesthesia material expenses were divided into variable and constant expenses that are partially common to both types and partially specific for each type of anesthesia. The sums of variable and specific expenses were compared between the two types of anesthesia, amounting to 78,26 HRK for sp...
Low flow anaesthesia: economic, eco friendly and effective
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Low flow anaesthesia, a technique introduced by Foldes in 1952 has resurged in clinical practice due to easy availability of low solubility inhalational agents. Being economical, ecological and clinically advantageous, it has initiated a renaissance in the field of anaesthesia. This study tested the safety and efficacy of LFA technique using Sevoflurane and its cost effectiveness. Materials and Method: A prospective observational study including 100 patients (ASA I/II,18-65 years) was conducted with the permission of institutional ethical committee and patient's consent. Selected patients were assigned into two groups by computer generated chit with fresh gas flow 3L and 0.5L in high and low flow group respectively. Chi square test and t test were used for stastical analysis. Primary objectives were to assess the economic efficacy of low flow technique and to compare the recovery characteristics of patients. Secondary objectives were to compare haemodynamic stability of patients in between two techniques. Result: Demographic data in both the groups were comparable. Both the techniques were comparable in terms of patient's haemodyanamic stability. Recovery was earlier in low flow group(p<0.05) with complete return of all reflexes. Consumption of sevoflurane was almost 2.5 times less in LFA group (p<0.001) as compared to high flow group. Conclusion: Low flow technique is a safe, economic & efficient technique of general anaesthesia.