To the authors' knowledge, this is the first report of a life-threatening adverse event due to haemodynamic instability during anidulafungin administration. Cardiac toxicity associated with echinocandins has been described. Further studies seem to be mandatory to investigate this potential risk.

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Keywords: Clinical pathway ± standard operating procedure ± cost assessment ± cardiac surgery. Schlu Èsselwo Èrter: Standardpfad ± clinical pathway ± standard operating procedure ± Prozeûkostenrechnung ± Herzchirurgie. Summary: Background: By developing a standard clinical pathway, we tried to assess the cost of a coronary bypass procedure at our in institution in order to find possibilities for cost containment and financial decision-making. Methods: A standard clinical pathway was designed for an aortocoronary bypass procedure. Using this pathway, we assessed the procedural costs in a stepwise manner for each individual patient to obtain the average cost for a bypass operation at our institution. Results: Overall costs for a standard coronary bypass operation at our institution were 7411 EUR. Costs for the surgical procedure, intensive care unit, intermediate care unit and 9 days on the ward were 3722 EUR, 1171 EUR, 271 EUR and 558 EUR, respectively. Expenses for personnel amounted to 3194 EUR; for drugs, 78 EUR; for disposables, 2919 EUR; for diagnostics, 274 EUR; and indirect costs, 609 EUR. Conclusions: Standard clinical pathways are a valid means for assessing procedural costs. Making costs transparent is the basis for cost containment, benchmarking and financial decision-making in cardiac surgery. (Eur. Surg. 2003; 35:51±54)