Comparison of cost effectiveness using low flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane versus using high flow anesthesia with an oxygen/nitrous oxide carrier gas sevoflurane during 2 hours anesthesia in abdominal surgery

Abstract

Background and Goal of Study:Interventional radiology (IR) came of age with the medical profession's desire to develop minimally invasive therapies1. Some of these procedures cause significant patient discomfort, and yet require relative patient immobility for optimal results calling for an increasing need for sedation and anaesthesia. Our study aimed to assess the provision of sedation service in IR. Materials and Methods: 101 radiology departments in acute hospital trusts in England and Wales responded to a telephone survey using a standardised questionnaire which was analysed. Results and Discussion: 76% of respondents were from the district general hospitals, 80% of which have dedicated IR lists. These provide services for hepatobiliary (84%), vascular (82%), cancer (68%), Gynaecology (61%), neuroradiology (23%) and miscellanous (25%). In 88% of the departments, a dedicated person, which may be a nurse (52%), radiologist (41%), anaesthetist (35%) and others (10%), provides sedation. Half of the departments have a sedation protocol and 49% of departments require a competency-based training for giving sedation. 20% of departments have a lead anaesthetist responsible for IR. 52% of the IR lists have anaesthetic cover and 81% of them have a dedicated anaesthetic assistant. Concerns about the safety and need of training of non-anaesthetic staff in the provision of sedation, monitoring and recovery of patients have been widely publicised1. Our survey revealed suboptimal involvement of anaesthetic departments in IR, and the lack of training for sedation provision. This may be due to poor inter-departmental co-operation and a general lack of resources. The Royal College of Radiologists 2 and the Joint Commission for Accreditation of Healthcare Organizations recommend that sedation practice throughout the hospitals be 'monitored and evaluated by the Department of Anaesthesia'3 Conclusion(s): We identified the need for further participation of anaesthetists in IR to provide a service, support, and to develop training for sedation provision by non-anaesthetists. This can be achieved by a lead anaesthetist in IR who maintains close links between the departments especially with regard to producing local protocols.

A Comparison of the Cost and Consumption of Sevoflurane and Litholyme at Total Gas Flow Rates of 1 and 2 Liters Per Minute: a Randomized Controlled Trial

“…This study found that the cost and consumption of sevoflurane in group 1 were significantly less than that in group 2. Our result was similar to previous studies 4,7,8 that reported that sevoflurane expenditure and costeffectiveness were significantly reduced in low-flow anesthesia patients. On the other hand, when the lower FGF was used, more exhaled CO 2 passed through the CO 2 absorbent, resulting in an increased consumption of CO 2 absorbent.…”

“…The sample size per group was 32, which was calculated using two independent means formulas: the two-tailed significance of 0.01 and the power of 0.9 based on previous data. 4 Because a drop-out rate of 10% was expected, the desired sample size was 35 subjects per group. The sample size required for this study was 70 patients.…”

The implementation of low‐flow anesthesia at a tertiary pediatric center: A quality improvement initiative

“…Sevoflurane is currently the most commonly used volatile anesthetic, and its use is uniquely increased in pediatric anesthesia due to the amount of inhalational inductions performed. A 2010 study from Albania demonstrated a significant decrease in the amount and cost of sevoflurane when using 1L FGF vs 4.5L FGF with sevoflurane in adults undergoing elective abdominal surgery lasting at least 2 hours 1 . This study demonstrated the cost‐saving potential of low‐flow anesthesia but did not quantify any environmental effect.…”

CO2 removal from anaesthesia circuits using gas-ionic liquid membrane contactors

“…Nitrous oxide (N2O) is the most used inorganic inhalational anaesthetic due to its proven pharmacokinetic properties and low cost (0.80€/L). The use of an inorganic gas with anaesthetic properties as N2O, allows to reduce the costs per operation, by reducing the amount of volatile halogenated hydrocarbons necessary to induce the anaesthetic state, which are significantly more expensive (Isoflurane -126€/L, sevoflurane -756€/L, Desflurane -806€/L) [12][13][14][15].…”

“…Therefore, the anaesthetic gas commonly used is nitrous oxide (N2O), due to its low cost (0.80 €/L). Moreover, the use of N2O allows to reduce the costs per operation, by reducing the amount of volatile anaesthetics necessary to induce the anaesthetic state, which are significantly more expensive (Isoflurane -126 €/L, sevoflurane -756 €/L, Desflurane -806 €/L) [12][13][14][15]. Other approach to reduce the costs is to rebreathe the remainder inhalational anaesthetics, performing the operation in a closedcircuit mode.…”