Desflurane improves the throughput of patients in the PACU. A cost-effectiveness
comparison with isoflurane.
Author(s): Beaussier M, Decorps A, Tilleul P, Megnigbeto A, Balladur P, Lienhart A.
Affiliation(s): Department of Anesthesia and Intensive Care, St Antoine University Hospital, and
the University Paris XIII, Paris, France. marc.beaussier@sat.ap-hop-paris.fr
Publication date & source: 2002, Can J Anaesth. , 49(4):339-46
PURPOSE: In a pharmacoeconomic approach of anesthesia, postanesthesia care unit
(PACU) occupancy can be chosen as a criteria of effectiveness to compare two
anesthetic drugs with different rates of elimination and different costs of
administration. Our objective was to develop a cost-effectiveness approach for
the comparison of isoflurane (I) and desflurane (D).
METHOD: In this prospective observational study, 68 patients aged 18-70 received
either D or I for maintenance of anesthesia for inpatient abdominal procedures.
Length of stay (LOS) in PACU was collected by a blinded observer. After the
relationship between duration of surgery and LOS in PACU had been established in
the 68 observed patients, we estimated the PACU occupancy according to duration
of surgery and time of admission in PACU using a computer model of 204
consecutive patients, based on the hypothesis of an exclusive use of either D or
I. Outcome measures were direct costs of the anesthesia procedure and occupancy
of the PACU.
RESULTS: The direct cost of the anesthetic was significantly higher with D than
with I. This represents an increase of CAN$ 2 708 for the 204 patients. PACU
occupancy was reduced by at least one patient (out of five beds) during 26.1% of
the time with D (P <0.01).
DISCUSSION: Improving the throughput of patients in PACU by using new halogenated
anesthetic agents with faster rates of elimination may outweigh the incremental
cost of this strategy. This becomes particularly meaningful in operating theatres
experiencing frequent overcrowded periods.
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