Comparison of economic effectiveness of desflurane and sevoflurane in ENT surgery

Cover Page


Cite item

Full Text

Abstract

Purpose. To determine the clinical and economic effectiveness of using desflurane and sevoflurane as components of general balanced anesthesia when performing ENT surgeries in children. Methods. 132 cases of general anesthesia were analyzed during adeno- and/or tonsillotomy. The mean age of patients was 6.2±2.8 years. The average duration of anesthesia was 44.1±13.3 min. Direct medical costs, cost efficiency and budgetary impact were analyzed based on the weighted average prices in 2018. Results. In adeno- or tonsillotomy of mid-duration in children the cost of anesthesia support was 483.31 RUB for desflurane, and 283.48 RUB for sevoflurane. The expenditure difference amounted to 199.83 in favor of sevoflurane. Changing from desflurane to sevoflurane in 1,000 patients under 18 years old who require inhalation anesthesia will be accompanied by cost saving in the amount of 199,830 RUB. When the anesthetic concentration is changed, sevoflurane is also a less expensive technology in patients aged 1–3, 3–5 and 5–12 years old. While using the minimum recommended flows of fresh gas, the cost of anesthesia support will constitute 295.3 RUB for desflurane and 173.69 RUB for sevoflurane with the difference in favor of sevoflurane being 121,61 RUB for 44.1-min surgery with 3-min initial narcosis. Conclusion. Use of sevoflurane as a component of general combined balanced anesthesia in adeno- and/or tonsillotomy in children is more cost-efficient as compared to desflurane.

About the authors

L. S. Zolotareva

Pirogov Russian National Research Medical University

Author for correspondence.
Email: l_zolotareva@mail.ru

Lyubov S. ZOLOTAREVA – Junior Researcher, Research Institute of Clinical Surgery

Ostrovityanov 1, Moscow, 117997
phone: +7(903)545–19–78 

Russian Federation

O. N. Paponov

N. F. Filatov Children’s Municipal Clinical Hospital No. 13

Email: fake@neicon.ru

Oleg N. PAPONOV – Anesthetist

Sadovaya‑Kudrinskaya st., 15, Moscow, 123001

Russian Federation

S. M. Stepanenko

Pirogov Russian National Research Medical University

Email: fake@neicon.ru

Sergei M. STEPANENKO – Dr. Sci. (Med.), Professor, Department of Pediatric Surgery

Ostrovityanov 1, Moscow, 117997

Russian Federation

A. V. Isakov

Pirogov Russian National Research Medical University

Email: fake@neicon.ru

Aleksandr V. ISAKOV – Cand. Sci. (Med.), Associate Professor, Department of Pediatric Surgery

Ostrovityanov 1, Moscow, 117997

Russian Federation

References

  1. Богомильский М. Р. Аденоиды. Вестник оториноларингологии. 2013;3:61–64
  2. Щетинин С. А., Коркмазов М. Ю., Гизингер О. А., Коченгина С. А., Сокол Е. В. Эффективность терапии хронического аденоидита у детей, проживающих в городе Челябинске, по результатам передней активной риноманометрии и цитокинового профиля смывов с поверхности глоточной миндалины. Вестник Челябинской областной клинической больницы. 2015; 3: 59–63
  3. Бойко Н. В., Бачурина А. С. Аденотомия и аденотонзиллотомия у детей с затруднением носового дыхания. Российская ринология. 2015;23(1):9–12 doi: 10.17116/rosrino20152319–12
  4. Thomas K., Boegerb D., Buentzelc J., Esserd D., Hoffmanne K., Jecker P., Mueller A., Radtke R., Geißler K., Finkensieper M., Guntinas-Lichius O. Pediatric adenoidectomy: A population-based regional study on epidemiology and outcome. International Journal of Pediatric Otorhinolaryngology. 2013;77:1716–20 doi: 10.1016/j.ijporl.2013.07.032
  5. Fedeli U., Marchesan M., Avossa F., Zambon F., Andretta M., Baussano I. Variability of adenoidectomy/tonsillectomy rates among children of the Veneto Region, Italy. BMC Health Services Research. 2009;9:25 doi: 10.1186/1472–69639–25
  6. Русецкий Ю. Ю., Лопатин А. С., Чернышенко И. О., Седых Т. К. Эволюция аденотомии (обзор литературы). Вестник оториноларингологии. 2013;78(4):23–6
  7. Clemens J., McMurray J.S., Willging J. P. Electrocautery versus curette adenoidectomy: comparison of postoperative results. International Journal of Pediatric Otorhinolaryngology. 1998;43(2):115–22
  8. Борзов Е. В. Особенности функционального состояния центральной нервной системы у детей с патологией глоточной миндалины. Вестник оториноларингологии. 2002;2:28–30
  9. Карпов В. А., Козлов В. С. Аденотомия под контролем гортанного зеркала. Российская ринология. 2000;4:27–30
  10. Мельников М. Н., Соколов А. С. Эндоскопическая шейверная аденоидэктомия. Российская ринология. 2000;1:4–8
  11. Сергеев Д. В., Мансурова С. Р. Эндоскопическая аденотомия у детей и ее эффективность. Новости оториноларингологии и логопатологии. 2001;1:93–94
  12. Сидоров В.А, Цыпин Л. Е., Гребенников В. А. Ингаляционная анестезия в педиатрии. Москва: Медицинское информационное агентство; 2010. 182 с.
  13. Katoh T., Ikeda K. The minimum alveolar concentration (MAC) of sevoflurane in humans. Anesthesiology. 1987;66:301–3
  14. Jones R. M., Cashman J. N., Eger E. I. 2nd, Damask M. C., Johnson B. H. Kinetics and potency of desflurance (I-653) in volunteers. Anesthesia and Analgesia. 1990;70:3–7 doi: 10.1213/00000539–199001000–00002
  15. Kehlet H., Wilmore D. W. Fast‐track surgery. British Journal of Surgery. 2005;92(1):3–4 doi: 10.1002/bjs.4841
  16. White P. F., Kehlet H., Neal J. M., Schricker T., Carr D. B., Carli F. Fast-Track Surgery Study Group. The role of the anesthesiologist in fast-track surgery: from multimodal analgesia to perioperative medical care. Anesthesia and Analgesia. 2007;104(6):1380–96 doi: 10.1213/01.ane.0000263034.96885.e1
  17. Dalal K. S., Choudhary M. V., Palsania A. J., Toal P. V. Desflurane for ambulatory anaesthesia: A comparison with sevoflurane for recovery profile and airway responses. Indian journal of anaesthesia. 2017;61(4):315 doi: 10.4103/ija.IJA_513_16
  18. Baum J. A., Aitkenhead A. R.. Low-flow anaesthesia. Anaesthesia. 1995 Oct;50 Suppl:37–44
  19. Лихванцев В. В. Практическое руководство по анестезиологии. 2-е изд. М.: Медицинское информационное агентство;2011;552 с.
  20. Droh R., Rolly G., Schepp R. Practical experience with more than 60,000 closed circuit anesthesias. Traditional and future implications of the closed circuit concept. Acta Anaesthesiologica Belgica. 1984;35(4):265–72
  21. Feldman J. M., Lo C., Hendrickx J. Estimating the Impact of Carbon Dioxide Absorbent Performance Differences on Absorbent Cost During Low-Flow Anesthesia. Anesthesia and Analgesia. 2019;Publish Ahead of Print doi: 10.1213/ANE.0000000000004059
  22. Исаков А. В., Папонов О. Н., Агавелян Э. Г., Степаненко С. М. Сравнение влияния севофлурана и десфлурана на показатели гемодинамики и послеоперационного восстановления в амбулаторной лор-хирургии у детей. Анестезиология и реаниматология. 2017;62(1):4–6
  23. Ultane (sevoflurane) volatile liquid for inhalation. Food and Drug Administration; 2019 [процитировано 11.07.2019]. Доступно: http://www.accessdata.fda.gov/drugsatfda_docs/label/2006/020478s016lbl.pdf
  24. Golembiewski J. Economic considerations in the use of inhaled anesthetic agents. American Journal of Health Pharmacy. 2010;67:S9–12 doi: 10.2146/ajhp100093
  25. Weinberg L., Story D., Nam J., McNicols L. Pharmacoeconomics of volatile inhalational anaesthetic agents: an 11-year retrospective analysis. Anaesthesia and Intensive Care. 2010;38(5):849–54 doi: 10.1177/0310057X1003800507
  26. Белоусов Д. Ю., Афанасьева Е. В., Ефремова Е. А. Сравнительная оценка экономической эффективности применения современных ингаляционных анестетиков. Качественная клиническая практика. 2014;(2):3–20
  27. Dion P. The cost of anaesthetic vapors. Canada Journal of Anaesthesia. 1992;39(6):633 doi: 10.1007/BF03008331
  28. Taylor R. H., Lerman J. Minimum alveolar concentration of desflurane and hemodynamic responses in neonates, infants, and children. Anesthesiology. 1991;75(6):975–9 doi: 10.1097/00000542–199112000–00008
  29. Katoh T., Ikeda K: Minimum alveolar concentration of sevoflurane in children. British Journal of Anaesthesia. 1992;68:139–41 doi: 10.1093/bja/68.2.139
  30. Lerman J., Sikich N., Kleinman S., Yentis S. The pharmacology of sevoflurane in infants and children. Anesthesiology. 1994;80:814–24 doi: 10.1097/00000542–199404000–00014
  31. Kumar G., Stendall C., Mistry R., Gurusamy K., Walker D. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Anaesthesia. 2014;69(10):1138–50 doi: 10.1111/anae.12713
  32. Martin T. M., Nicolson S. C., Bargas M. S. Propofol anesthesia reduces emesis and airway obstruction in pediatric outpatients. Anesthesia and Analgesia. 1993;76:144–8 doi: 10.1213/00000539–199301000–00024
  33. Watcha M. F.. Postoperative nausea and emesis. Anesthesiology Clinics of North America. 2002;20:709–22
  34. Watcha M. F., White P. F. Postoperative nausea and vomiting. Its etiology, treatment, and prevention. Anesthesiology. 1992;77:162–84 doi: 10.1097/00000542–199207000–00023
  35. Shirakami G., Teratani Y., Namba T., Hirakata H., Tazuke-Nishimura M., Fukuda K. Delayed discharge and acceptability of ambulatory surgery in adult outpatients receiving general anesthesia. Journal of Anesthesia. 2005;19:93–101 doi: 10.1007/s00540–004–0297–6
  36. Carroll N. V., Miederhoff P. A., Cox F. M., Hirsch J. D. Costs incurred by outpatient surgical centers in managing postoperative nausea and vomiting. Journal of Clinical Anesthesia. 1994;6:364–9
  37. DeBalli P. The use of propofol as an antiemetic. International Anesthesiology Clinics. 2003;41:67–77
  38. Ravenelle F., Gori S., Le Garrec D., Lessard D., Luo L., Palusova D., Sneyd J. R., Smith D. Novel lipid and preservativefree propofol formulation: properties and pharmacodynamics. Pharmaceutical Research. 2008;25:313–9 doi: 10.1007/s11095–007–9471–5
  39. Eilers H., Cattaruzza F., Nassini R., Materazzi S., Andre E., Chu C., Cottrell G. S., Schumacher M., Geppetti P., Bunnett N. W. Pungent general anesthetics activate transient receptor potential‐A1 to produce hyperalgesia and neurogenic bronchoconstriction. Anesthesiology. 2010;112:1452–63 doi: 10.1097/ALN.0b013e3181d94e00
  40. White P. F., Tang J., Wender R. H., Yumul R., Stokes O. J., Sloninsky A., Naruse R., Kariger R., Norel E., Mandel S., Webb T., Zaentz A. Desflurane versus sevoflurane for maintenance of outpatient anesthesia: the effect on early versus late recovery and perioperative coughing. Anesthesia and Analgesia. 2009;109:387–93 doi: 10.1213/ane.0b013e3181adc21a
  41. Boldt J., Jaun N., Kumle B., Heck M., Mund K. Economic considerations of the use of new anesthetics: a comparison of propofol, sevoflurane, desflurane, and isoflurane. Anesthesia and Analgesia. 1998;86(3):504–9 doi: 10.1097/00000539-199803000–00010

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2019 Zolotareva L.S., Paponov O.N., Stepanenko S.M., Isakov A.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: ПИ № ФС 77 - 81892 от 24.09.2021 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies