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Canadian Journal of Anesthesia 52:551-552 (2005)
© Canadian Anesthesiologists' Society, 2005

Correspondence

Desflurane costs in ambulatory anesthesia

Peter Harris, MA BSc BM BCH FRCA

Derbyshire Royal Infirmary, Derby, UK E-mail: peter.harris{at}derbyhospitals.nhs.uk

To the Editor:

The report by Schwarz et al.1 on the comparative costs of isoflurane and desflurane for ambulatory anesthesia prompted me to retrieve a similar but smaller analysis I undertook when desflurane was introduced into our hospital in 1995. The procedures were of comparable duration (mean 29.3 min), mainly for hernias and varicose veins. The inductions were with sevoflurane (shown at the time to be comparable in price to the cost of a propofol induction). Maintenance was with desflurane with minimal supplements of nitrous oxide and alfentanil. The desflurane was titrated to a MAC range of 1.2 to 1.4, and the fresh gas flows were reduced to run a closed circuit as soon as this MAC was achieved. In the absence of a precision balance, my estimates of desflurane consumption came from a record of gas flow and vaporizer settings. The calibrations of the vaporizer were in good agreement with the indications on the vapour analyzer. The mean desflurane consumption came to 9.5 mL per patient, equivalent to $3.88 using the drug prices in the Schwarz paper (e.g., their values of 18.6 mL for 29 min, costing $7.61). Out of interest I repeated the costing with isoflurane in a similar cohort of patients. The mean procedure duration was 25.8 min; the mean isoflurane consumption was 3.1 mL per patient, costing $0.43 (e.g., 6.0 mL for 25 min procedures costing $0.83 in the Schwarz paper). There is no doubt that isoflurane is cheaper to use in this context, but the savings resulting from the use of a closed circuit are equally impressive. In this era of routine monitoring of the expired gases, there is no justification for the maintenance of anesthesia with flows as high as 1 L·min–1.

Reference

1 Schwarz SK, Butterfield NN, MacLeod BA, Kim EY, Franciosi LG, Ries CR. Under "real world" conditions, desflurane increases drug cost without speeding discharge after short ambulatory anesthesia compared to isoflurane. Can J Anesth 2004; 51: 892–8.[Abstract/Free Full Text]


Related articles in CJA:

REPLY
Stephan K. W. Schwarz, Bernard A. MacLeod, and Craig R. Ries
CJA 2005 52: 552. [Full Text]  




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