在麻醉监测护理期间，美索比妥与丙泊酚用于镇静的成本效益比较。

The cost-effectiveness of methohexital versus propofol for sedation during monitored anesthesia care.

作者信息

Sá Rêgo M M, Inagaki Y, White P F

机构信息

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, USA.

出版信息

Anesth Analg. 1999 Apr;88(4):723-8. doi: 10.1097/00000539-199904000-00005.

DOI:10.1097/00000539-199904000-00005

PMID:10195511

Abstract

UNLABELLED

We designed this study to test the hypothesis that methohexital is a cost-effective alternative to propofol for sedation during local anesthesia. Sixty consenting women undergoing breast biopsy procedures under local anesthesia were randomly assigned to receive an infusion of either propofol (50 microg x kg(-1) x min(-1)) or methohexital (40 microg x kg(-1) x min(-1)). The sedative infusion rate was titrated to maintain an observer's assessment of alertness/sedation (OAA/S) score of 3 (with 1 = awake/alert to 5 = asleep). Fentanyl 25 microg i.v. was administered as a "rescue" analgesic during the operation. We assessed the level of sedation (OAA/S score), vital signs, time to achieve an OAA/S score of 3 at the onset and a score of 1 after discontinuing the infusion, discharge times, perioperative side effects, and patient satisfaction. The direct cost of methohexital was lower than that of propofol, based on the milligram dosage infused during the operation. The sedative onset (to achieve an OAA/S score of 3) and the recovery (to return to an OAA/S score of 1) times, as well as discharge times, did not differ between the two groups. Patients receiving methohexital had a significantly lower incidence of pain on initial injection compared with those receiving propofol (10% vs 23%). Because the use of methohexital (29.4 +/- 2.7 microg x kg(-1) x min(-1)) for sedation during breast biopsy procedures has a similar efficacy and recovery profile to that of propofol (36.8 +/- 15.9 microg x kg(-1) x min(-1)) and is less costly based on the amount infused, it seems to be a cost-effective alternative to propofol for sedation during local anesthesia. However, when the cost of the drug infused and drug wasted was calculated, there was no difference in the overall drug cost.

IMPLICATIONS

When administered to maintain a stable level of sedation during local anesthesia, methohexital is an acceptable alternative to propofol. However, the overall drug costs were similar with the two drugs.

摘要

未标注

我们设计本研究以检验以下假设：在局部麻醉期间，美索比妥是丙泊酚用于镇静的一种具有成本效益的替代药物。60名同意参与的女性在局部麻醉下接受乳房活检手术，她们被随机分配接受丙泊酚（50微克·千克⁻¹·分钟⁻¹）或美索比妥（40微克·千克⁻¹·分钟⁻¹）输注。镇静输注速率进行滴定调整，以维持观察者对警觉/镇静（OAA/S）评分为3分（1分为清醒/警觉，5分为入睡）。术中静脉注射25微克芬太尼作为“解救”镇痛药。我们评估了镇静水平（OAA/S评分）、生命体征、开始输注时达到OAA/S评分为3分以及停止输注后恢复到1分的时间、出院时间、围手术期副作用和患者满意度。根据术中输注的毫克剂量计算，美索比妥的直接成本低于丙泊酚。两组之间的镇静起效时间（达到OAA/S评分为3分）、恢复时间（恢复到OAA/S评分为1分）以及出院时间并无差异。与接受丙泊酚的患者相比，接受美索比妥的患者首次注射时疼痛发生率显著更低（10%对23%）。因为在乳房活检手术期间使用美索比妥（29.4±2.7微克·千克⁻¹·分钟⁻¹）进行镇静与丙泊酚（36.8±15.9微克·千克⁻¹·分钟⁻¹）具有相似的疗效和恢复情况，并且基于输注量成本更低，所以在局部麻醉期间用于镇静，它似乎是丙泊酚具有成本效益的替代药物。然而，当计算输注药物和浪费药物的成本时，总体药物成本并无差异。