Michael K. Rosenberg

Cost comparison : a desflurane-versus a propofol-based general anesthetic technique

The purpose of this study was to compare the cost of a desflurane-based with a propofol-based general anesthetic technique. Fifty ambulatory orthopedic surgery patients were randomly assigned to one of two groups. Premedication and induction of anesthesia were standardized in both groups. In Group I patients, anesthesia was maintained with a propofol infusion and nitrous oxide-oxygen and in Group II patients, with desflurane-oxygen. The techniques used were identical to those routinely used with these drugs by our practitioners. The actual drug acquisition costs for the maintenance periods were calculated and compared, as was the duration of the postanesthesia care unit (PACU) stay (Phase I + Phase II). The drug acquisition cost for the maintenance period of general anesthesia with our desflurane-based technique was

Hyponatremic Encephalopathy After Rollerball Endometrial Ablation

11.24/h and for our propofol-based technique,

Comparison of Midazolam/ketamine with Methohexital for Sedation During Peribulbar Block

44.08/h. The length of PACU stay was not significantly different in the two groups. In conclusion, maintenance general anesthesia with our desflurane technique was considerably less expensive than with our propofol technique. PACU stay was not increased using desflurane as opposed to propofol in our study. Desflurane offers a cost effective alternative to propofol for ambulatory general anesthesia.

The cost of oxygen therapy in the postanesthesia care unit.

I n recent years transcervical endoscopic endometrial ablation has become an alternative to hysterectomy for the treatment of dysfunctional uterine bleeding. Ablation can be performed using laser technology (Nd-YAG laser) (1) or electrosurgical diathermy, commonly referred to as the “rollerball” procedure (2). A major difference in the two techniques, from the anesthesiologist’s standpoint, is the use of a low viscosity hypotonic distention/irrigation medium (1.5% glycine or 3% sorbitol) during rollerball ablation as opposed to 0.9% saline during laser ablation. The intravascular absorption of hypotonic solutions can lead to hyponatremia, which may progress to hyponatremic encephalopathy. Hyponatremic encephalopathy is particularly hazardous to premenopausal women.

The Cost of Propofol

A nesthesiologists are often required to perform retrobulbar blocks (RBB) or peribulbar blocks (PBB) for ophthalmic surgical procedures, as well as to simultaneously sedate patients. Drugs that have been utilized for sedation include methohexital (l-3), alfentanil (2,4), midazolam (31, and propofol (3,5). Patient movement and/or respiratory problems during block placement may increase the incidence of complications, such as optic nerve and vessel damage, retrobulbar hemorrhage, central nervous system complications, and globe perforation (6). So that the anesthesiologist can focus on performing the block, and thus avoid complications (7,8), it is important that a sedation technique be used which is associated with minimal patient movement or respiratory difficulty. In this study we describe a low-dose midazolam/ketamine sequence and compare it with a commonly used methohexital technique.