Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive Care2219-40612587-6554Eco-Vector62710.30946/2219-4061-2019-9-4-69-77Comparison of economic effectiveness of desflurane and sevoflurane in ENT surgeryZolotarevaL. S.<p>Lyubov S. ZOLOTAREVA – Junior Researcher, Research Institute of Clinical Surgery</p><p>Ostrovityanov 1, Moscow, 117997<br />phone: +7(903)545–19–78 </p>l_zolotareva@mail.ruPaponovO. N.<p>Oleg N. PAPONOV – Anesthetist</p><p>Sadovaya‑Kudrinskaya st., 15, Moscow, 123001</p>fake@neicon.ruStepanenkoS. M.<p>Sergei M. STEPANENKO – Dr. Sci. (Med.), Professor, Department of Pediatric Surgery</p><p>Ostrovityanov 1, Moscow, 117997</p>fake@neicon.ruIsakovA. V.<p>Aleksandr V. ISAKOV – Cand. Sci. (Med.), Associate Professor, Department of Pediatric Surgery</p><p>Ostrovityanov 1, Moscow, 117997</p>fake@neicon.ruPirogov Russian National Research Medical UniversityN. F. Filatov Children’s Municipal Clinical Hospital No. 13221220199469772204202022042020Copyright © 2019, Zolotareva L.S., Paponov O.N., Stepanenko S.M., Isakov A.V.2019<strong>Purpose</strong>. To determine the clinical and economic effectiveness of using desflurane and sevoflurane as components of general balanced anesthesia when performing ENT surgeries in children. <strong>Methods</strong>. 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. <strong>Results</strong>. 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. <strong>Conclusion</strong>. 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.desfluranesevofluraneanesthesiabalanced anesthesiacosts and cost analysisдесфлурансевофлурананестезиясбалансированная анестезиязатраты и анализ затрат[Богомильский М. Р. Аденоиды. Вестник оториноларингологии. 2013;3:61–64][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][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][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][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][Русецкий Ю. Ю., Лопатин А. С., Чернышенко И. О., Седых Т. К. Эволюция аденотомии (обзор литературы). Вестник оториноларингологии. 2013;78(4):23–6][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][Борзов Е. В. Особенности функционального состояния центральной нервной системы у детей с патологией глоточной миндалины. Вестник оториноларингологии. 2002;2:28–30][Карпов В. А., Козлов В. С. Аденотомия под контролем гортанного зеркала. Российская ринология. 2000;4:27–30][Мельников М. Н., Соколов А. С. Эндоскопическая шейверная аденоидэктомия. Российская ринология. 2000;1:4–8][Сергеев Д. В., Мансурова С. Р. Эндоскопическая аденотомия у детей и ее эффективность. Новости оториноларингологии и логопатологии. 2001;1:93–94][Сидоров В.А, Цыпин Л. Е., Гребенников В. А. Ингаляционная анестезия в педиатрии. Москва: Медицинское информационное агентство; 2010. 182 с.][Katoh T., Ikeda K. The minimum alveolar concentration (MAC) of sevoflurane in humans. Anesthesiology. 1987;66:301–3][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][Kehlet H., Wilmore D. W. Fast‐track surgery. British Journal of Surgery. 2005;92(1):3–4 DOI: 10.1002/bjs.4841][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][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][Baum J. A., Aitkenhead A. R.. Low-flow anaesthesia. Anaesthesia. 1995 Oct;50 Suppl:37–44][Лихванцев В. В. Практическое руководство по анестезиологии. 2-е изд. М.: Медицинское информационное агентство;2011;552 с.][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][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][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][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][Golembiewski J. Economic considerations in the use of inhaled anesthetic agents. American Journal of Health Pharmacy. 2010;67:S9–12 DOI: 10.2146/ajhp100093][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][Белоусов Д. Ю., Афанасьева Е. В., Ефремова Е. А. Сравнительная оценка экономической эффективности применения современных ингаляционных анестетиков. Качественная клиническая практика. 2014;(2):3–20][Dion P. The cost of anaesthetic vapors. Canada Journal of Anaesthesia. 1992;39(6):633 DOI: 10.1007/BF03008331][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][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][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][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][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][Watcha M. F.. Postoperative nausea and emesis. Anesthesiology Clinics of North America. 2002;20:709–22][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][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][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][DeBalli P. The use of propofol as an antiemetic. International Anesthesiology Clinics. 2003;41:67–77][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][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][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][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]