Evaluation of cost minimization strategies of anaesthetic drugs in a tertiary care hospital

Hawkes, Chris; Miller, Donald R.; Martineau, Raymond; Hull, Kathryn A.; Hopkins, Harry S.; Tiemey, Michael

doi:10.1007/bf03010931

Cited by 41 publications

(19 citation statements)

References 16 publications

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“…17 Muscle relaxant expenditures are between 20-40% of the cumulative anesthesia drug budget. This study shows that once a stable level of neuromuscular block is achieved, hourly maintenance costs of CIS ($3.57 ± 0.09) are less (approximately 40%) than hourly costs of rocuronium ($6.03 ± 0.27).…”

Section: Discussionmentioning

confidence: 99%

Cumulation characteristics of cisatracurium and rocuronium during continuous infusion

Miller

Wherrett

Hull

et al. 2000

Can J Anesth/J Can Anesth

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Purpose: The dissimilar pharmacokinetic properties of cisatracurium (CIS) and rocuronium (ROC) predict different potential for drug cumulation when these drugs are administered by continuous infusion. A study was therefore undertaken to compare cumulation potential of CIS and ROC during surgical procedures of relatively long duration (2-4 hr). Methods: Sufentanil/propofol-N 2 O anesthesia was administered to 40 ASA I and II adults. In a double-blind protocol, patients were randomly allocated to receive a continuous iv infusion of either CIS or ROC, titrated in progressive increments or decrements as required to achieve and maintain 95 ± 5% depression of the T1 response of the adductor pollicis muscle, using a Datex NMT-100 Relaxograph EMG monitor applied at the wrist. At the end of surgery, 60 µg·kg -1 neostigmine plus 15 µg·kg -1 atropine were administered for reversal. Results: The duration of infusion was 104 ± 33 min in group CIS and 110 ± 23 min in group ROC (P=NS). In both groups, a progressive decrease in potency-adjusted infusion rates was observed after 30 min, then stabilized beyond 60 min. When allowing for an initial period of stabilization, mean potency-adjusted infusion requirements were: CIS 0.81 ± 0.02 µg·kg -1 ·min -1 and ROC 5.58 ± 1.94 µg·kg -1 ·min -1 . There were no differences between groups at any time with regard to potency-adjusted infusion requirements necessary to maintain 90-99% block (P=NS). However, drug costs/hr for maintenance of neuromuscular block were less with CIS ($3.57 ± 0.09) than with ROC ($6.03 ± 0.27), P < 0.001. Conclusion: When adjusted to equipotency, infusion requirements of CIS and ROC vary at similar rates during general anesthesia. Despite pharmacokinetic differences, neither drug demonstrates cumulation for infusion lasting up to 3.5 hr.Objectif : Les propriétés pharmacocinétiques différentes du cisatracurium (CIS) et du rocuronium (ROC) laissent présager un potentiel différent d'accumulation lorsqu'on les administre en perfusion continue. Une étude a donc été menée pour comparer le potentiel d'accumulation de CIS et de ROC pendant des interventions chirurgicales de durée relativement longue (2-4 h). Méthode : Une anesthésie à base de sufentanil/propofol-N 2 O a été administrée à 40 adultes d'état physique ASA I et II. Selon un protocole à double insu, les patients ont été répartis de façon aléatoire et ont reçu une perfusion iv continue de CIS ou de ROC en doses progressives ou dégressives comme l'exigent la réalisation et le maintien d'une dépression de 95 ± 5 % de la réponse à T1 du muscle adducteur du pouce, en utilisant un moniteur Datex NMT-100 Relaxograph EMG appliqué au poignet. À la fin de l'opération, 60 µg·kg -1 de néostigmine et 15 µg·kg -1 d'atropine ont été administrés pour renverser le bloc. Résultats : La perfusion a duré 104 ± 33 min dans le groupe CIS et 110 ± 23 min dans le groupe ROC (P=NS). Dans les deux groupes, une baisse progressive des vitesses de perfusion ajustée en fonction de la puissance a été observée après 30 min, puis stabilisée a...

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Section: Discussionmentioning

confidence: 99%

Cumulation characteristics of cisatracurium and rocuronium during continuous infusion

Miller

Wherrett

Hull

et al. 2000

Can J Anesth/J Can Anesth

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“…Economic Anaesthetic drugs constitute only a small proportion of hospital pharmacy expenses; nitrous oxide is inexpensive and halothane is relatively so, but other inhalational anaesthetics are more costly and may account for more than 20% of anaesthetic drug expenditure. 6 Anaesthetic costs are related to the amounts used and hence to flow rates. Educational efforts to encourage the reduction of gas flows to 1.5 1.min -1 resulted in the average anaesthetic cost decreasing from US $19.20 • 1.16 to US $15.16 • 0.39 at the University of Michigan, where volatile anaesthetics accounted for 25% of the anaesthetic drug expenditure in 1992-3.…”

Section: Any Anaesthetists Have Received Littlementioning

confidence: 99%

Low and minimal flow inhalational anaesthesia

Baxter

1997

Can J Anaesth

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Low and minimal flow inhalational anaesthesiaPurpose: To describe the pharmacokinetic behaviour and practical aspects of low (0.5-I l.min ~) and minimal (0.25-0.5 l.min i) flow anaesthesia. Methods: A Medline search located articles on low flow anaesthesia, and computer simulated anaesthetic uptake models are used. Principal findings: Host, 85-9096, of anaesthetists use high fresh gas flow rates during inhalational anaesthesia. Low/minimal flow anaesthesia with a circle circuit may avoid the need for in-circuit humidifiers, raise the temperature of inspired gases by up to 6~ reduce cost by about 2596 by reduction of fresh gas flows to 1.5 l.min -~ , and reduce environmental pollution with scavenged gas. Knowledge of volatile anaesthetic pharmacokinetic behaviour facilitates the use of minimalllow flow rates. Small amounts of nitrogen or minute amounts of methane, acetone, carbon monoxide, and inert gases in the circuit are of no concern, but the degradation of desflurane (to carbon monoxide by dry absorbent) and sevoflurane (to compound A by using a fresh gas flow of >2 l-rain-') must be avoided. With modem gas monitoring technology, safety should be no more of a concern than with high flow techniques. Conclusion: The use of fresh gas flow rates of < I l-min -~ for maintenance of anaesthesia has many advantages, and should be encouraged for inhalational anaesthesia with most modem volatile anaesthetics.

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“…We must all be aware of costs and of methods of reduction. In a tertiary referral Canadian hospital, application of a cost-awareness programme resulted in a reduction in anaesthetic drug cost from 5.7% of the pharmacy budget to 4.6%, corresponding figures for the total hospital budget being 0.3% and 0.24% respectively [5]. Thus, in 1991 the cost per case was Can.$30.3 (approximately f 1 5), which had decreased to Can326.2 (E13) in 1993.…”

Section: Editorialmentioning

confidence: 99%