title: EEG bispectral index monitoring in sevoflurane or propofol anaesthesia: analysis of direct costs and immediate recovery.
abstract: BACKGROUND
  Recent studies have suggested that electroencephalogram (EEG) bispectral index (BIS) monitoring can improve recovery after anaesthesia and save money by shortening patients' postoperative stay. We wanted to evaluate the direct costs of BIS monitoring and to measure immediate recovery after anaesthesia in patients with or without BIS monitoring.
  
  
  METHODS
  Eighty patients undergoing gynaecological surgery were studied. At first, 40 patients were randomized to receive either propofol or sevoflurane anaesthesia. In these patients, BIS was collected but the information was not displayed. Thereafter, the anaesthesiologists were trained to follow and understand the BIS information, and 40 patients were anaesthetized with aid of the monitoring. Recovery times were measured by a study coordinator. Drug consumption was calculated.
  
  
  RESULTS
  BIS monitoring improved the immediate recovery after propofol anaesthesia, while no differences were seen in patients receiving sevoflurane. The consumption of both propofol and sevoflurane decreased significantly (29% and 40%, respectively). BIS monitoring increased direct costs in these patients; the break-even times (704 min for propofol and 282 min for sevoflurane) were not reached.
  
  
  CONCLUSIONS
  BIS monitoring decreased the consumption of both propofol and sevoflurane and hastened the immediate recovery after propofol anaesthesia. Detailed cost analysis showed that the monitoring increased direct costs of anaesthesia treatment in these patients, mainly due to the price of special EEG electrodes used for relatively short anaesthesias.
authors.affiliation: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Yli-Hankala
authors.forename: A
authors.initials: A
authors.lastname: Vakkuri
authors.forename: P
authors.initials: P
authors.lastname: Annila
authors.forename: K
authors.initials: K
authors.lastname: Korttila
mesh_terms: D000328:Adult; D000368:Aged; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000191:economics; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000191:economics; D003365:Costs and Cost Analysis; D004180:Direct Service Costs; D004569:Electroencephalography / Q000191:economics* / Q000295:instrumentation; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics*; D015742:Propofol / Q000008:administration & dosage* / Q000191:economics; D020127:Recovery of Function; D000077149:Sevoflurane; D012815:Signal Processing, Computer-Assisted; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol