丙泊酚与七氟醚的成本降低分析：使用脑电双频指数维持妇科手术麻醉

Cost-reduction analysis of propofol versus sevoflurane: maintenance of anaesthesia for gynaecological surgery using the bispectral index.

作者信息

Struys M M R F, Somers A A L, Van Den Eynde N, Herregods L L G, Dyzers D, Robays H M, Mortier E P

机构信息

Ghent University Hospital, Department of Anaesthesia, Ghent, Belgium.

出版信息

Eur J Anaesthesiol. 2002 Oct;19(10):727-34. doi: 10.1017/s0265021502001187.

DOI:10.1017/s0265021502001187

PMID:12463384

Abstract

BACKGROUND AND OBJECTIVE

The study was designed to compare the costs of propofol versus sevoflurane for the maintenance of the hypnotic component of anaesthesia during general anaesthesia, guided by the bispectral index, for gynaecological laparoscopic surgery.

METHODS

Forty ASA Grade I-II female patients scheduled for gynaecological laparoscopy were randomly allocated to two groups. All patients received a continuous infusion of remifentanil (0.25 microg kg(-1) min(-1)) for 2 min. Then anaesthesia was induced with propofol 1% at 300 mL h(-1) until loss of consciousness. To guide the bispectral index between 40 and 60, Group 1 patients received propofol 10 mg kg(-1) h(-1) initially, which was increased or decreased by 2 mg kg(-1) h(-1) steps; Group 2 patients received sevoflurane, initially set at 2 vol.% and adjusted with steps of 0.2-0.4%. The time and quality of anaesthesia and recovery were assessed in two postoperative standardized interviews.

RESULTS

Patient characteristics, the propofol induction dose, the bispectral index and the haemodynamic profiles during induction of anaesthesia, and its duration, were similar between the groups. In Group 1, 7.55 +/- 1.75 mg kg(-1) h(-1) propofol and in Group 2, 0.20 +/- 0.09 mL kg(-1) h(-1) liquid sevoflurane were used for maintenance. The cost for maintenance, including wasted drugs, was higher when using propofol (Euro 25.14 +/- 10.69) than sevoflurane (Euro 12.80 +/- 2.67). Postoperatively, recovery profiles tended to be better with propofol; however, the day after discharge no differences were found.

CONCLUSIONS

When applying the bispectral index to guide the administration of hypnotic anaesthetic drugs, propofol-based maintenance of anaesthesia was associated with the highest cost. A trend towards a better recovery profile was obtained with propofol. However, on the day after discharge, no differences in quality were observed.

摘要

背景与目的

本研究旨在比较在双谱指数引导下，丙泊酚与七氟醚用于妇科腹腔镜手术全身麻醉期间维持麻醉催眠成分的成本。

方法

40例计划行妇科腹腔镜手术的美国麻醉医师协会（ASA）Ⅰ-Ⅱ级女性患者被随机分为两组。所有患者均接受瑞芬太尼持续输注（0.25微克·千克⁻¹·分钟⁻¹）2分钟。然后用1%丙泊酚以300毫升·小时⁻¹诱导麻醉直至意识消失。为将双谱指数控制在40至60之间，1组患者最初接受10毫克·千克⁻¹·小时⁻¹丙泊酚，以2毫克·千克⁻¹·小时⁻¹的步长增减；2组患者接受七氟醚，初始设定为2体积%，以0.2-0.4%的步长调整。在术后两次标准化访谈中评估麻醉和恢复的时间及质量。

结果

两组患者的特征、丙泊酚诱导剂量、麻醉诱导期间的双谱指数和血流动力学参数及其持续时间相似。1组维持麻醉使用7.55±1.75毫克·千克⁻¹·小时⁻¹丙泊酚，2组使用0.20±0.09毫升·千克⁻¹·小时⁻¹液体七氟醚。包括浪费药物在内的维持成本，使用丙泊酚（25.14±10.69欧元）高于七氟醚（12.80±2.67欧元）。术后，丙泊酚组的恢复情况倾向于更好；然而，出院后一天未发现差异。