The rate of complete blocks without the use of transpectoral sonography in our clinic and in the literature was approximately 72%, whereas using transpectoral ultrasound it was 96.5%. None of the 86 patients with transpectoral sonography required general anaesthesia. The onset time using transpectoral sonography was approximately 6 min. The perivascular axillary plexus block, combined with transpectoral sonography, is an effective and efficient procedure.

Procedure-related costs were calculated for an operating theatre with 10 operating rooms. The variable parameter was the different hygiene regimens for the preparation of the anaesthesia circuit. In April 2003 a change was made for the whole anaesthesia area. Either change of the anaesthesia tube system after every patient or the use of a hydrophobic HME-F (heat and moisture exchange filter) with daily or weekly change of the anaesthesia tube system were calculated. All costs were ascertained on real findings and typical procedures. Data according to safety and hygienic value were discussed and supplemented by our own findings about perioperative pneumonia. The additional costs for the HME-F are covered by the savings for CO(2) lines and the reduction of reprocessing expenses and overall material costs were reduced. The operational work on anaesthesia machines decreased considerably. Combined cost types revealed savings up to 9,72 EUR for a single anaesthesia procedure. Filtration of the respiratory gases for particles, bacteria, viruses and airway climatisation is an additional positive effect of HME-F use. Incidence of postoperative pneumonia on intensive care units was monitored by KISS (German hospital infection surveillance system) and the change to the HME-F regimen did not indicate a higher risk of infection. By the implementation of a weekly change of the anaesthesia tube system using HME filters a hygienic management for anaesthesia circuit reprocessing was found which could mobilize considerable resources.