Boldt J, Jaun N, Kumle B, Heck M, Mund K
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Akademisches Lehrkrankenhaus der Universität Mainz, Germany.
Anesth Analg. 1998 Mar;86(3):504-9. doi: 10.1097/00000539-199803000-00010.
Cost control in anesthesia is no longer an option; it is a necessity. New anesthetics have entered the market, but economic differences in comparison to standard anesthetic regimens are not exactly known. Eighty patients undergoing either subtotal thyroidectomy or laparoscopic cholecystectomy were randomly divided into four groups, with 20 patients in each group. Group 1 received propofol 1%/sufentanil, Group 2 received desflurane/sufentanil, Group 3 received sevoflurane/sufentanil, and Group 4 received isoflurane/sufentanil (standard anesthesia) for anesthesia. A fresh gas flow of 1.5-2 L/min and 60% N2O in oxygen was used for maintenance of anesthesia, and atracurium was given for muscle relaxation. Concentrations of volatile anesthetics, propofol, and sufentanil were varied according to the patient's perceived need. Isoflurane, desflurane, and sevoflurane consumption was measured by weighing the vaporizers with a precision weighing machine. Biometric data, time of surgery, and time of anesthesia were similar in the four groups. Times for extubation and stay in the postanesthesia care unit (PACU) were significantly longer in the isoflurane group. Use of sufentanil and atracurium did not differ among the groups. Propofol patients required fewer additional drugs in the PACU (e.g., antiemetics), and thus showed the lowest additional costs in the PACU. Total (intra- and postoperative) costs were significantly higher in the propofol group ($30.73 per patient; $0.24 per minute of anesthesia). The costs among the inhalational groups did not differ significantly (approximately $0.15 per minute of anesthesia). We conclude that in today's climate of cost savings, a comprehensive pharmacoeconomic approach is needed. Although propofol-based anesthesia was associated with the highest cost, it is doubtful whether the choice of anesthetic regimen will lower the costs of an anesthesia department.
Cost analysis of anesthetic techniques is necessary in today's economic climate. Consumption of the new inhaled drugs sevoflurane and desflurane was measured in comparison to a standard anesthetic regimen using isoflurane and an IV technique using propofol. Propofol-based anesthesia was associated with the highest costs, whereas the costs of the new inhaled anesthetics sevoflurane and desflurane did not differ from those of a standard, isoflurane-based anesthesia regimen.
麻醉中的成本控制已不再是一种选择，而是一种必要。新的麻醉药已进入市场，但与标准麻醉方案相比的经济差异尚不完全清楚。80例行甲状腺次全切除术或腹腔镜胆囊切除术的患者被随机分为四组，每组20例。第一组接受1%丙泊酚/舒芬太尼，第二组接受地氟烷/舒芬太尼，第三组接受七氟烷/舒芬太尼，第四组接受异氟烷/舒芬太尼（标准麻醉）进行麻醉。维持麻醉时采用1.5 - 2 L/min的新鲜气流和60%的氧化亚氮/氧气，并给予阿曲库铵用于肌肉松弛。挥发性麻醉药、丙泊酚和舒芬太尼的浓度根据患者的需求进行调整。异氟烷、地氟烷和七氟烷的消耗量通过用精密称重机称量挥发罐来测量。四组患者的生物特征数据、手术时间和麻醉时间相似。异氟烷组的拔管时间和在麻醉后恢复室（PACU）的停留时间明显更长。舒芬太尼和阿曲库铵的使用在各组之间没有差异。丙泊酚组患者在PACU需要的额外药物（如止吐药）较少，因此在PACU的额外费用最低。丙泊酚组的总（术中及术后）费用明显更高（每位患者30.73美元；每麻醉分钟0.24美元）。吸入组之间的费用没有显著差异（每麻醉分钟约0.15美元）。我们得出结论，在当今节约成本的环境下，需要一种全面的药物经济学方法。尽管基于丙泊酚的麻醉成本最高，但麻醉方案的选择是否会降低麻醉科的成本仍值得怀疑。
在当今的经济环境下，麻醉技术的成本分析是必要的。与使用异氟烷的标准麻醉方案和使用丙泊酚的静脉技术相比，测量了新吸入药物七氟烷和地氟烷的消耗量。基于丙泊酚的麻醉成本最高，而新吸入麻醉药七氟烷和地氟烷的成本与基于异氟烷的标准麻醉方案的成本没有差异。
