title: Irrigation with Liquid Sevoflurane and Healing of a Postoperative, Recurrent Epidural Infection: A Potential Cost-Saving Alternative.
abstract: BACKGROUND
  The general inhalation anesthetic sevoflurane can be used for the topical treatment of complicated wounds. It is applied in liquid form and may be used to irrigate the inside of cavities. Sevoflurane also exhibits in vitro antimicrobial activity. Therefore, sevoflurane may be used as an alternative to typical antibiotic or surgical treatment of complicated, localized infections.
  
  
  METHODS
  The case of a 61-year-old male patient who suffered a cranioencephalic trauma 18 years previously is presented. The patient underwent surgeries related to the trauma on numerous occasions. To date, he has suffered various recurrent epidural abscesses, which have been treated with surgical cleaning and antibiotic treatment. In the most recent episode, he presented a frontal epidural abscess 25 mm in diameter with fistulization of the skin. The patient gave written informed consent to be treated with sevoflurane irrigation, and the Pharmacy Service authorized the off-label use. Sevoflurane was applied via a catheter placed inside the cavity during weekly outpatient procedures. The procedures began 8 weeks after the clinically and radiologically verified recovery of the abscess. By avoiding surgery and the associated hospital admission, this novel alternative may prevent patient morbidity and, furthermore, may produce important economic savings.
  
  
  CONCLUSIONS
  The treatment of complicated wounds with liquid sevoflurane may be an effective and economically efficient clinical alternative for some patients.
authors.affiliation: Department of Neurosurgery, University Hospital Complex of Albacete, Albacete, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Ferrara
authors.affiliation: Department of Pharmacy, University Hospital Complex of Albacete, Albacete, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Domingo-Chiva
authors.affiliation: Area of Political Economy, Faculty of Economic Science of Albacete, Castilla La Mancha University, Albacete, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Selva-Sevilla
authors.affiliation: Department of Neurosurgery, University Hospital Complex of Albacete, Albacete, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Campos-García
authors.affiliation: Department of Anesthesiology, University Hospital Complex of Albacete, Albacete, Spain. Electronic address: sergepu@hotmail.com.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gerónimo-Pardo
mesh_terms: D017046:Cost Savings / Q000191:economics; D020802:Epidural Abscess / Q000188:drug therapy* / Q000191:economics; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000191:economics; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000191:economics; D012008:Recurrence; D000077149:Sevoflurane; D012996:Solutions / Q000008:administration & dosage; D013030:Spain; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000191:economics; D007507:Therapeutic Irrigation / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D008738:Methyl Ethers; D010975:Platelet Aggregation Inhibitors; D012996:Solutions; D000077149:Sevoflurane
keywords: Anesthetics; Anti-infective agents; Cost savings; Epidural abscess; Hospital costs; Inhalation; Local; Sevoflurane; Surgical wound infection