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

Correspondence

REPLY

Stephan K. W. Schwarz, MD DR MED PHD FRCPC, Bernard A. MacLeod, MD FRCPC and Craig R. Ries, MD FRCPC PhD

University of British Columbia, Vancouver, Canada, E-mail: stephan.schwarz{at}ubc.ca

We thank Dr. Harris for his interest in our trial and are grateful for the opportunity to reply. We agree that low-flow anesthesia utilizing modern closed-circuit anesthesia delivery systems is associated with decreased volatile agent consumption, and, hence, decreased volatile agent cost, compared to higher flows. This topic has been subject of review in the literature,1,2 and was discussed in our publication.3 However, our trial was neither intended nor designed to study the pharmacoeconomics of ultra-low-flow anesthesia. Nevertheless, isoflurane is significantly less expensive than desflurane, even under ultra-low-flow conditions;4 Dr. Harris’ conclusions are in agreement with these findings. Regarding Dr. Harris’ statement that "there is no justification for the maintenance of anesthesia with flows as high as 1 L·min–1", a reduction from 1 L·min–1 to 0.5 L·min–1 of fresh gas flow produces no significant reduction in isoflurane consumption.4 As we have insufficient information available on the experimental design, methods, and actual flow rates used by Dr. Harris, we are unable to make more detailed comments on his results. We look forward to his publication on this important matter.

References

1 Baum JA, Aitkenhead AR. Low-flow anaesthesia. Anaesthesia 1995; 50(Suppl): 37–44.

2 Suttner S, Boldt J. Low-flow anaesthesia. Does it have potential pharmacoeconomic consequences? Pharmacoeconomics 2000; 17: 585–90.[Medline]

3 Schwarz SKW, Butterfield NN, MacLeod BA, Kim E, 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]

4 Coetzee JF, Stewart LJ. Fresh gas flow is not the only determinant of volatile agent consumption: a multicentre study of low-flow anaesthesia. Br J Anaesth 2002; 88: 46–55.[Abstract/Free Full Text]


Related articles in CJA:

Desflurane costs in ambulatory anesthesia
Peter Harris
CJA 2005 52: 551-552. [Full Text]  




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