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Cost-effectiveness and high patient satisfaction in the elderly: sevoflurane versus propofol anaesthesia

Published online by Cambridge University Press:  23 December 2004

S. P. Luntz
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
E. Janitz
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
J. Motsch
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
A. Bach
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
E. Martin
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
B. W. Böttiger
Affiliation:
University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany
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Abstract

Summary

Background and objective: The use of propofol compared with isoflurane is associated with improved patient comfort and decreased costs. However, as the cost saving, the quicker recovery time and patient comfort may not be evident if sevoflurane is substituted for isoflurane; these two anaesthetic agents were analysed in elderly patients.

Methods: In a prospective randomized study, 96 patients undergoing elective ophthalmic surgery received either total intravenous anaesthesia with propofol (Group P), propofol for induction and sevoflurane for maintenance (Group P/S) or sevoflurane for inhalation induction and maintenance (Group S). Analyses focussed on haemodynamics, the quality of recovery, and the costs for the anaesthetic and the entire procedure.

Results: Bradycardia or hypotension, mainly registered in Groups P and P/S, did not influence patients' recovery. In Group S, postoperative nausea and vomiting occurred frequently, and 50% of patients complained of discomfort during induction. In Group P/S, the costs for anaesthetics and total costs were lower than those in Groups P and S.

Conclusions: Propofol- and sevoflurane-based maintenance of anaesthesia were similar with regard to patient comfort and recovery in the elderly. Cost analysis revealed that it was less expensive to use propofol for induction and sevoflurane for maintenance than to use either propofol or sevoflurane as sole agents for anaesthesia.

Type
Original Article
Copyright
2004 European Society of Anaesthesiology

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References

Bartamian M, Meyer DR. Site of service, anesthesia, and postoperative practice patterns for oculoplastic and orbital surgeries. Ophthalmology 1996; 103: 16281633.Google Scholar
Mangano DT. Perioperative cardiac morbidity. Anesthesiology 1990; 72: 153184.Google Scholar
Walley T, Haycox A. Pharmacoeconomics: basic concepts and terminology. Br J Clin Pharmacol 1997; 43: 343348.Google Scholar
Suttner S, Boldt J, Schmidt C, Piper S, Kumle B. Cost analysis of target-controlled infusion-based anesthesia compared with standard anesthesia regimens. Anesth Analg 1999; 88: 7782.Google Scholar
Epple J, Kubitz J, Schmidt H, et al. Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil versus balanced anaesthesia with isoflurane and fentanyl. Eur J Anaesthesiol 2001; 18: 2028.Google Scholar
Janshon GP, Thomas H. Mask induction and one-lung ventilation with sevoflurane. Anaesthesist 1998; 47: S52S57.Google Scholar
Bond AJ, Lader MH. The use of analogue scales in rating subjective feelings. Br J Med Psychol 1974; 47: 211218.Google Scholar
Aldrete JY. The post-anesthesia recovery score revisited. J Clin Anesth 1995; 7: 8991.Google Scholar
Simonson E, Brozek J. Flicker fusion frequency, background and applications. Physiol Review 1952; 32: 349378.Google Scholar
Steinberg H. Selective effects of an anesthetic drug on cognitive behaviour. Quart J Exp Psychol 1954; 6: 170180.Google Scholar
Weiskopf RB, Eger EI II. Comparing the costs of inhaled anesthetics. Anesthesiology 1993; 79: 14131418.Google Scholar
Rosenberg MK, Bridge P, Brown M. Cost comparison: a desflurane- versus a propofol-based general anesthetic technique. Anesth Analg 1994; 79: 852855.Google Scholar
Raeder J, Gupta A, Pedersen FM. Recovery characteristics of sevoflurane- or propofol-based anaesthesia for day-care surgery. Acta Anaesthesiol Scand 1997; 41: 988994.Google Scholar
Blake DW, Hogg MN, Hackman CH, Pang J, Bjorksten AR. Induction of anaesthesia with sevoflurane, preprogrammed propofol infusion or combined sevoflurane/propofol for laryngeal mask insertion: cardiovascular, movement and EEG bispectral index responses. Anaesth Intensive Care 1998; 26: 360365.Google Scholar
Gravel NR, Searle NR, Taillefer J, et al. Comparison of the hemodynamic effects of sevoflurane anesthesia induction and maintenance versus TIVA in CABG surgery. Can J Anaesth 1999; 46: 240246.Google Scholar
Dashfield AK, Birt DJ, Thurlow J, Kestin IG, Langton JA. Recovery characteristics using single-breath 8% sevoflurane or propofol for induction of anaesthesia in day-case arthroscopy patients. Anaesthesia 1998; 53: 10621066.Google Scholar
Einarsson S, Bengtsson A, Stenqvist O, Bengtson JP. Decreased respiratory depression during emergence from anaesthesia with sevoflurane/N2O than with sevoflurane alone. Can J Anaesth 1999; 46: 335341.Google Scholar
Hall JE, Stewart JIM, Harmer M. Single-breath inhalation induction of sevoflurane anaesthesia with and without nitrous oxide: a feasibility study in adults and comparison with an intravenous bolus of propofol. Anaesthesia 1997; 52: 410415.Google Scholar
Jakobsson I, Heidvall M, Davidson S. The sevoflurane-sparing effect of nitrous oxide: a clinical study. Acta Anaesthesiol Scand 1999; 43: 411414.Google Scholar
Nishiyama T, Aibiki M, Hanaoka K. Haemodynamic and catecholamine changes during rapid sevoflurane induction with tidal volume breathing. Can J Anaesth 1997; 44: 10661070.Google Scholar
Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double-blind comparison with propofol. Br J Anaesth 1997; 78: 356361.Google Scholar
Walpole R, Logan M. Effect of sevoflurane concentration on inhalation induction of anaesthesia in the elderly. Br J Anaesth 1999; 82: 2024.Google Scholar
Tang J, Chen L, White PF, et al. Recovery profile, costs, and patient satisfaction with propofol and sevoflurane for fast-track office-based anesthesia. Anesthesiology 1999; 91: 253261.Google Scholar
Kubitz J, Epple J, Bach A, et al. Psychomotor recovery in very old patients after intravenous or balanced anaesthesia for cataract surgery. Br J Anaesth 2001; 86: 203208.Google Scholar
Fredman B, Nathanson MH, Smith I, et al. Sevoflurane for outpatient anesthesia: a comparison with propofol. Anesth Analg 1995; 81: 823828.Google Scholar
Smith I, Terhoeve PA, Hennart D, et al. A multicentre comparison of the costs of anaesthesia with sevoflurane or propofol. Br J Anaesth 1999; 83: 564570.Google Scholar
Apfel CC, Kranke P, Katz MH, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomised controlled trial of factorial design. Br J Anaesth 2002; 88: 659668.Google Scholar
Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol 1998; 15: 433445.Google Scholar
Dashfield A. Postoperative nausea and vomiting following 8% sevoflurane anaesthesia. Anaesthesia 2000; 55: 190191.Google Scholar
Loop T, Priebe HJ. Recovery after anesthesia with remifentanil combined with propofol, desflurane, or sevoflurane for otorhinolaryngeal surgery. Anesth Analg 2000; 91: 123129.Google Scholar
Muzi M, Robinson BJ, Ebert TJ, O'Brien TJ. Induction of anesthesia and tracheal intubation with sevoflurane in adults. Anesthesiology 1996; 85: 536543.Google Scholar
Philip BK, Lombard LL, Philip JH. Vital capacity induction with sevoflurane in adult surgical patients. J Clin Anesth 1996; 8: 426.Google Scholar
Rowe WL. Economics and anaesthesia. Anaesthesia 1998; 53: 782788.Google Scholar
Schlunzen L, Simonson MS, Spangsberg NL, Carlsson P. Cost consciousness among anaesthetic staff. Acta Anaesthesiol Scand 1999; 43: 202205.Google Scholar
Body SC, Fanikos J, DePeiro D, Philip JH, Segal BS. Individualized feedback of volatile agent use reduces fresh gas flow rate, but fails to favorably affect agent choice. Anesthesiology 1999; 90: 11711175.Google Scholar