Comparative cost analysis of three different anesthesia methods in gynecological laparoscopic surgery

Abstract

In the current study, we assessed and evaluated the costs and benefits of three popular methods of general anesthesia practiced in our department for gynecological laparoscopic surgery in recent years. Sixty adult female patients who underwent elective gynecological laparoscopic surgery under general anesthesia were randomly divided into three groups: group V, group I and group C. In group V, anesthesia was induced intravenously with midazolam, remifentanil, propofol and vecuronium, and maintained with continuous infusion of propofol and remifentanil. In group I, anesthesia was intravenously induced with midazolam, fentanyl, propofol and vecuronium, and maintained with inhaled isoflurane and intravenous bonus of fentanyl. In group C, anesthesia was induced as in group I, but maintained with isoflurane inhalation combined with propofol-remifentanil infusion. All patients received vecuronium for muscle relaxation. Perioperative incidences of complications and total anesthesia costs for patients in all groups were recorded. In addition, postoperative satisfaction of the patients was also noted, and similar outcomes of the satisfaction were reported in all 60 patients. Although there was no statistical significance among groups, the incidence of postoperative nausea and vomiting were higher in group C, and the rates of shivering and the needs for analgesics were higher in group V. Anesthesia costs in group I were the lowest. Therefore, it is concluded that the costs of anesthesia induced with midazolam, fentanyl, propofol, vecuronium, and maintained with isoflurane, fentanyl and vecuronium are cheapest, and there is no significant difference in patients’ satisfaction and safety among the three above-mentioned methods of anesthesia in our department.

Keywords

general anesthesia / economics / cost

References

[1] Epple J, Kubitz J, Schmidt H, Motsch J, Böttiger BW, Martin E, Bach A. Comparative analysis of costs of total intravenous anaesthesia with propofol and remifentanil vs. balanced anaesthesia with isoflurane and fentanyl. Eur J Anaesthesiol2001; 18(1): 20-28

[2] Anari S, Ainsworth G, Robson AK. Cost-efficiency of endoscopic and external dacryocystorhinostomy. J Laryngol Otol2008; 122(5): 476-479

[3] Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, de Ferranti D. Reform of how health care is paid for in China: challenges and opportunities. Lancet2008; 372(9652): 1846-1853

[4] Chernin EL. Pharmacoeconomics of inhaled anesthetic agents: considerations for the pharmacist. Am J Health Syst Pharm2004; 61(Suppl 4): S18-S22

[5] Watcha MF, White PF. Economics of anesthetic practice. Anesthesiology1997; 86(5): 1170-1196

[6] Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev2007; (4): CD003843

[7] Aldrete JA. The post-anesthesia recovery score revisited. J Clin Anesth1995; 7(1): 89-91

[8] Chi X, Wang X, Chen Y. Cost-Efficiency Analysis of Three Different Anesthesia Methods. Anesthesiology2008; 109: A1041(ASA annual meeting abstract, 2008, Orlando, FL)

[9] Gerges FJ, Kanazi GE, Jabbour-Khoury SI. Anesthesia for laparoscopy: a review. J Clin Anesth2006; 18(1): 67-78

[10] Orkin FK. Moving toward value-based anesthesia care. J Clin Anesth1993; 5(2): 91-98

[11] Juckenhöfel S, Feisel C, Schmitt HJ, Biedler A. TIVA with propofol-remifentanil or balanced anesthesia with sevoflurane-fentanyl in laparoscopic operations. Hemodynamics, awakening and adverse effects. Anaesthesist1999; 48(11): 807-812 (in German)

[12] Nho JS, Lee SY, Kang JM, Kim MC, Choi YK, Shin OY, Kim DS, Kwon MI. Effects of maintaining a remifentanil infusion on the recovery profiles during emergence from anaesthesia and tracheal extubation. Br J Anaesth2009; 103(6): 817-821

[13] Green G, Jonsson L. Nausea: the most important factor determining length of stay after ambulatory anaesthesia. A comparative study of isoflurane and/or propofol techniques. Acta Anaesthesiol Scand1993; 37(8): 742-746

[14] Chandrakantan A, Glass PSA. Multimodal therapies for postoperative nausea and vomiting, and pain. Br J Anaesth2011; 107(Suppl 1): i27-i40

Acknowledgements

The authors would like to thank the patients, gynoclogicists and nurse staff both in operating room and recovery room. We thank all staff in Department of Anesthesiology (Tongji Hospital) for their advice and assistance. In addition, we gratefully acknowledge the expertise of Dr. Alfred Omo (Department of Cardiothoracic Surgery, Tongji Hospital) and Mr. Edwin V. Alexander (Department of Neuroscience, Baylor College of Medicine) in the preparation of the manuscript. This work was supported by the research fund from Tongji Hospital to Xueren Wang.

RIGHTS & PERMISSIONS

2014 Higher Education Press and Springer-Verlag Berlin Heidelberg