A First-Pass Cost Analysis of Propofol Versus Barbiturates for Children Undergoing Magnetic Resonance Imaging

Kain, Zeev N.; Gaal, Dorothy; Kain, Tatiana S.; Jaeger, David D.; Rimar, Stephen

doi:10.1097/00132586-199506000-00021

Cited by 16 publications

(25 citation statements)

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“…Most studies show a more rapid recovery and discharge to home or the hospital ward when propofol is used compared with other sedative agents, and it is the agent that most anesthesiologists use for general anesthesia for MRI. 13 However, apnea requiring ventilatory support occurs more often when intravenous propofol is used for sedation for MRI than with pentobarbital. 14 Also, although new automatic infusion pumps that are compatible with MRI are being developed, continuous administration of propofol currently requires regulating the rate of drug administration with a drip chamber or mechanical flow regulator.…”

Section: Discussionmentioning

confidence: 99%

“…14 Also, although new automatic infusion pumps that are compatible with MRI are being developed, continuous administration of propofol currently requires regulating the rate of drug administration with a drip chamber or mechanical flow regulator. 13 This may cause inaccurate drug administration, increase the workload of the nurse, and distract from patient observation. In contrast, longer acting agents such as pentobarbital can be administered by bolus.…”

Section: Discussionmentioning

confidence: 99%

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Trained nurses can provide safe and effective sedation for MRI in pediatric patients

Beebe

Tran

Bragg

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: To determine the success rate, safety and complications using a standard protocol and trained nurses to provide sedation for MRI under the supervision of a radiologist. Materials and Methods:Nurses were trained to provide sedation via a standard protocol for pediatric patients undergoing diagnostic MRI. Oral chloral hydrate (80-100 mg·kg -1 ) was used for children less than 18 mo of age. Older children received either 1-6 mg·kg -1 pentobarbital iv, with or without 1-2 µg·kg·hr -1 fentanyl, or 25 mg·kg -1 thiopental pr. Sedation was defined as successful if it allowed completion of the MRI without image distorting patient movement. The records of 572 MRIs performed on 488 pediatric patients (mean age 5 ± 4 yr; age 2 mo-14 yr) from 1991 to July 1995 were reviewed to determine the success rate and complications using the sedation program.Results: Most, 91.8% (525/572), of the MRIs were successfully completed in 445 patients. The reasons for failure were inadequate sedation (45, 95.7%) and coughing (2, 4.2%). The failure rate was much higher before 1994 (38/272, 14%) than after (9/300, 3%; P < 0.0001). Failure was more common if rectal thiopental was used (23/172, 14%) than intravenous pentobarbital (19/256, 7.4%; P < 0.05). The failure rate was also high in patients with a history of a behavioural disorder (10/59,17%). There were no deaths or unexpected admissions as a result of the sedation program. Conclusion:A high success rate can be achieved as experience is gained using a standard protocol and trained nurses to sedate children for MRI. Méthode : Des infirmières ont été formées pour administrer la sédation selon un protocole standard à des patients pédiatriques devant subir un examen diagnostique d'IRM. L'hydrate de chloral oral (80-100 mg·kg -1 ) a servi pour les enfants de moins de 18 mois. Les plus âgés ont reçu soit 1-6 mg·kg -1 de pentobarbital iv, avec ou sans 1-2 µg·kg·hr -1 de fentanyl, soit 25 mg·kg -1 de thiopental pr. On considérait la sédation réussie quand l'IRM était achevé sans distorsion d'image par un mouvement du patient. Les enregistrements de 572 IRM réalisés chez 488 enfants (âge moyen de 5 ± 4 ans; limite d'âge de 2 mois-14 jrs) de 1991 à juillet 1995 ont été revus pour l'évaluation du taux de succès et des complications liés au programme de sédation.Résultats : La plupart des examens d 'IRM, 91,8 % (525/572), ont été réalisés avec succès chez 445 patients. Les échecs ont eu pour cause une sédation insuffisante (45, 95,7 %) et la toux (2, 4,2 %). Le taux d'échec a été beaucoup plus élevé avant 1994 (38/272, 14 %) qu'après (9/300, 3 %; P < 0,0001). L'échec était plus fréquent avec l'usage de thiopental rectal (23/172, 14 %) qu'avec le pentobarbital intraveineux (19/256, 7,4 %; P < 0,05). Le taux d'échec a été élevé également chez les patients qui présentaient des antécédents de troubles de comportement (10/59, 17 %). Aucun cas de décès ou d'admission imprévue n'a résulté de ce programme de sédation.Conclusion : Un fort taux de réussite peut être atteint à mesure que se développe l...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trained nurses can provide safe and effective sedation for MRI in pediatric patients

Beebe

Tran

Bragg

et al. 2000

Can J Anesth/J Can Anesth

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show abstract

“…Often, neuroimaging of infants and young children is performed under sedation (Kain et al, 1994;Merola et al, 1995), and functional magnetic resonance imaging (fMRI) studies of sedated children show that words activate specific brain regions (Altman and Bernal, 2001;Souweidane et al 1999). In addition, we have shown that a child under sedation responds selectively to the sound of her own first name (Carmody et al, in press).…”

Section: Introductionmentioning

confidence: 99%

Brain activation when hearing one's own and others' names

Carmody

Lewis

2006

Brain Research

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Using functional magnetic resonance imaging, brain activation patterns were examined in response to hearing one's own first name in contrast to hearing the names of others. There are several regions in the left hemisphere that show greater activation to one's own name, including middle frontal cortex, middle and superior temporal cortex, and cuneus. These findings provide evidence that hearing one's own name has unique brain functioning activation specific to one's own name in relation to the names of others.

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“…Several researchers claim that propofol lowers costs by reducing the time that a patient spends in the operating or recovery room (Enlund, Kobosko, & Rhodin, 1996;Kain, Gaal, Kain, Jaeger, & Rimar, 1994;Sung, Reiss, & Tillette, 1991;Suver et al, 1995;Tagliente, 1997;Wagner & O'Hara, 1995). However, equating recovery times to cost savings may be incorrect.…”

Section: Problem Of Reducing Costsmentioning

confidence: 99%

“…They found that better scheduling of admissions would maximize personnel productivity and reduce charges as personnel costs are directly related to the peak number of patients in the PACU. Kain et al (1994) found that PACU costs in the Magnetic Resonance Imaging (MRI) suite were reduced with propofol, but that savings came because the recovery room nurse transferred to the main surgical PACU when the patient recovered or was discharged from the MRI PACU. These results may not reflect typical surgical results because the barbiturate group used for comparison received both thiopental and pentobarbital for anesthesia maintenance which may have prolonged recovery.…”

Section: Problem Of Reducing Costsmentioning

confidence: 99%

Comparison Of The Direct Costs, Length Of Recovery, And Incidence Of Post Operative Anti Emetic Use After Anesthesia Induction With Propofol Or A 1:1 Mixture Of Thiopental And Propofol

Killpack¹

1999

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Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. The modern anesthesia provider must consider drug costs as important as benefits and risks when choosing which drug to use in an anesthetic. Thiopental has been the gold standard for an IV induction drug although propofol shows a better recovery profile with less post-operative nausea and vomiting, but at a higher cost. We attempted to determine if a 1:1 volume mixture of thiopental and propofol would show a similar recovery profile compared to propofol alone, but at a lower cost. This study examined the records of 212 surgery patients receiving propofol (n=82) or a 1:1 mixture (n=130) for demographic, peri-operative, PACU recovery, anti-emetic use, and cost data. We found that the propofol group had significantly more females, postoperative anti-emetic use, and induction drug costs, while the 1:1 mixture group had significantly longer surgery and anesthesia times. Mean post-operative anti-emetic drug costs were statistically significant (P<0.05) at $3.15 for the propofol group and $1.08 for the 1:1 mixture group. The mean cost of induction for the propofol group was $27.31 and $14.31 for the 1:1 mixture group, a statistically significant (P<0.05) difference of $13.09. The average recovery time for the propofol group was 134 minutes and cost $1205.37, and for the 1:1 mixture group 147 minutes and cost $1320.03. Thus, the difference in PACU charges was $114.66. This research suggests that the 1:1 mixture of thiopental and propofol produced a similar recovery profile to propofol alone, but at a lower direct cost. This study supported previous work, and recommends that further research be done to confirm its findings. ix ACKNOWLEDGEMENT SUBJECT TERMS

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A First-Pass Cost Analysis of Propofol Versus Barbiturates for Children Undergoing Magnetic Resonance Imaging

Cited by 16 publications

References 0 publications

Trained nurses can provide safe and effective sedation for MRI in pediatric patients

Trained nurses can provide safe and effective sedation for MRI in pediatric patients

Brain activation when hearing one's own and others' names

Comparison Of The Direct Costs, Length Of Recovery, And Incidence Of Post Operative Anti Emetic Use After Anesthesia Induction With Propofol Or A 1:1 Mixture Of Thiopental And Propofol

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