$1.8 Million and counting: how volatile agent education has decreased our spending $1000 per day

Miller, Scott; Aschenbrenner, Carol A.; Traunero, Justin R; Bauman, Loren A.; Lobell, Samuel S.; Kelly, Jeffrey S.; Reynolds, John E.

doi:10.1016/j.jclinane.2016.07.003

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…Anesthesiologists have to choose most cost-effective anesthetic technique without compromising service quality or patient safety. A large part the anesthetic drug budget is related to the cost of consumed inhaled anesthetic [3,15,16]. In our study, Mean Sevoflurane consumption per anesthesia hour was significantly lower when EtC was applied.…”

Section: Discussionmentioning

confidence: 49%

Automated control of end-tidal sevoflurane in living donor hepatectomy, a prospective, randomized, controlled study

Kandeel

Elmorshedi

Abdalla

et al. 2017

Egyptian Journal of Anaesthesia

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Background: Reduction of anesthesia cost has become a necessity, especially in developing countries. Recently, automated control of end-tidal sevoflurane concentration (EtSev) has been proposed as a new technique with both cost-effectiveness and safety profiles. In this study, sevoflurane consumption (primary outcome variable) was evaluated during living donor hepatectomy using automated control of EtSev (EtC) at fresh gas flow (FGF) of 0.5 and 2 L/min compared to manual control (MC) technique at FGF of 2 L/min. Materials and methods: Prospective, randomized, controlled trial including 60 Potential donors scheduled for living donor right hepatectomy. patients were randomized into 3 equal groups (according to target control of sevoflurane), MC group, EtC-2L group, and EtC-0.5L group. In MC group: FGF was set to 2 L/ min, inspired concentration of Sevoflurane (FiSev) was set to 1.5-2% in 0.4 fractional inspired oxygen concentration (FiO2), while in EtC-2L group: FGF was set to 2 L/min, EtSev was set to 1-1.5% with end tidal oxygen concentration (EtO2) target of 0.35. In EtC-0.5L group, FGF was set to minimal flow and EtSev target to 1-1.5% and EtO2 target of 0.35. Anesthetic gases consumption (sevoflurane ml, Oxygen L, and air consumption L) per anesthesia hour were recorded at the end of surgery. Other recorded data included intraoperative hemodynamics, the number of user adjustments, and extubation time. Results: Significant reduction in sevoflurane consumption when EtC-0.5L is used (4.2 ± 1.3 ml/h, 12.6 ± 2.6 ml/h, and 15 ± 2.9 ml/h respectively, p. 0.001). Also, a significant decrease in overall numbers of user adjustments between the three groups (8 times for EtC-0.5L group, 7 times in EtC-2L group, 22 times for MC group, p. 0.008) was observed. Conclusion: automated control of EtSev during anesthesia of living donor hepatectomy significantly lowers sevoflurane consumption and decreases required user interventions without deleterious effect on patient safety.

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Section: Discussionmentioning

confidence: 49%

Automated control of end-tidal sevoflurane in living donor hepatectomy, a prospective, randomized, controlled study

Kandeel

Elmorshedi

Abdalla

et al. 2017

Egyptian Journal of Anaesthesia

View full text Add to dashboard Cite

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“…Alors que la disponibilité de versions génériques de ces agents a réduit la différence de coût par rapport à l'isoflurane, dans la plupart des pays, ils demeurent tout de même considérablement (cinq à huit fois) plus onéreux que l'isoflurane. 7,8 D'importantes économies ont été documentées grâce à des initiatives éducationnelles encourageant l'utilisation accrue d'isoflurane. 7 Dans plusieurs pays à revenu élevé, le déclin de l'utilisation de l'isoflurane ne s'est pas appuyé sur des données probantes attestant de la supériorité clinique de nouveaux agents.…”

Section: Les Relations De Dose-réponse Pour Ses Nombreux Effets Seconunclassified

“…7,8 D'importantes économies ont été documentées grâce à des initiatives éducationnelles encourageant l'utilisation accrue d'isoflurane. 7 Dans plusieurs pays à revenu élevé, le déclin de l'utilisation de l'isoflurane ne s'est pas appuyé sur des données probantes attestant de la supériorité clinique de nouveaux agents. Là où les données sont disponibles, comme par exemple en chirurgie cardiaque, il semble n'y avoir aucun avantage à utiliser des agents plus onéreux.…”

Section: Les Relations De Dose-réponse Pour Ses Nombreux Effets Seconunclassified

“…While the availability of generic versions of these agents has reduced the cost differential compared with isoflurane, they still remain substantially (five to eight times) more expensive than isoflurane in most countries. 7,8 Significant cost savings have been documented through educational initiatives that have encouraged an increased use of isoflurane. 7 The shift away from isoflurane in many high-income countries has not been based on evidence of clinical superiority of the newer agents.…”

mentioning

confidence: 99%

“…7,8 Significant cost savings have been documented through educational initiatives that have encouraged an increased use of isoflurane. 7 The shift away from isoflurane in many high-income countries has not been based on evidence of clinical superiority of the newer agents. Where data are available, for example in cardiac surgery, there appears to be no advantage to the use of more costly agents.…”

mentioning

confidence: 99%

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