Under "real world" conditions, desflurane increases drug cost without speeding discharge after short ambulatory anesthesia compared to isoflurane.
OBJECTIVE
To compare the measured "real world" perioperative drug cost and recovery associated with desflurane- and isoflurane-based anesthesia in short (less than one hour) ambulatory surgery.


METHODS
We conducted a prospective, randomized, blinded trial with patients undergoing arthroscopic meniscectomy under general anesthesia. Following iv induction, patients received either isoflurane (group I; n = 25) or desflurane (group D; n = 20) for maintenance. The primary outcome variable was total perioperative drug cost per patient in Canadian dollars. Secondary outcome variables included volatile agent consumption and cost, adjuvant anesthetic and postanesthesia care unit (PACU) drug cost, readiness for PACU discharge, and incidence of adverse events.


RESULTS
Total perioperative drug cost per patient was 14.58 +/- 6.83 Canadian dollars (mean +/- standard deviation) for group I, and 21.47 +/- 5.18 Canadian dollars for group D (P < 0.001). Isoflurane consumption per patient was 6.0 +/- 3.0 mL compared to 18.6 +/- 7.7 mL for desflurane (P < 0.0001); corresponding costs were 0.83 +/- 0.42 Canadian dollars vs 7.61 +/- 3.15 Canadian dollars (P < 0.0001). There were no differences in adjuvant anesthetic or PACU drug cost. All but one patient from each group were deemed ready for PACU discharge at 15 min postoperatively (Aldrete score >or= 9). One patient in group D experienced postoperative nausea. No other adverse events were noted.


CONCLUSIONS
Measured total perioperative drug cost for a short ambulatory procedure (less than one hour) under general anesthesia was higher when desflurane rather than isoflurane was used for maintenance, essentially due to volatile agent cost. Desflurane use did not translate into faster PACU discharge under "real world" conditions.
Schwarz
Stephan K W
SK
Centre for Anesthesia and Analgesia, Department of Anesthesia, The University of British Columbia, Vancouver, British Columbia, Canada. stephan.schwarz@ubc.ca
Butterfield
Noam N
NN
Macleod
Bernard A
BA
Kim
Edward Y
EY
Franciosi
Luigi G
LG
Ries
Craig R
CR
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000191:economics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000191:economics*; D001182:Arthroscopy; D000077335:Desflurane; D016527:Drug Costs; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D008875:Middle Aged; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000209:etiology; D011446:Prospective Studies; D016037:Single-Blind Method; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D000077335:Desflurane; D007530:Isoflurane