Robert E. Johnstone

Costs of anesthesia

he practice of anesthesia faces many of the conflicting demands for better technology, lower T costs, improved outcome, and tighter control found in our current health care environment. The providers of anesthesia must make decisions amid demands from surgical patients, hospitals, purveyors of technology, and nonpatient payers. These anesthesia providers, in addition to being expensive themselves, order preoperative tests, control operating and recovery room usage, and consume large amounts of hospital supplies and services. Expenditures controlled by anesthesia providers represent 3-5% of the total health care costs of the United States. (Anesthesia provider charges approximate

Costs of anesthetic drugs: experiences with a cost education trial.

9 billion per year. Roizen estimates

Intravenous Δ9-tetrahydrocannabinol: Effects on Ventilatory Control and Cardiovascular Dynamics

11.7 billion for preoperative tests [personal communication]. Anesthesia supply and facility charges are unknown. Total health care costs are approximately

Effects of Acute and Chronic Ethanol Administration on Isoflurane Requirement in Mice

800 billion [ll.) The market for surgery and anesthesia does not follow conventional supply/ demand and cost/quality equilibrium laws (2). This is known as market failure, a situation that calls for special strategies for controlling costs and assessing tradeoffs. Investigating and understanding these strategies in the anesthesia market may produce strategies for other health care markets, such as intensive care medicine, which operate under similar conditions of market failure and consume large amounts of health care dollars (3). Anesthesiology is a facility-based service integral to quality health care, without which most surgery and much intensive care would not be possible (4). Approximately 26 million surgical procedures are performed in the United States each year. The contribution to, and control of, large dollar expenditures in this market by anesthesia providers, as well as insurance companies and other payer groups, requires their inclusion in studies of delivering and paying for quality health care. Analyzing the costs and cost determinants, as well as the risks, benefits, and effectiveness of

Reversal of Morphine Anesthesia with Naloxone

D emands for better outcomes using new equipment, drugs, and techniques confront anesthesiology. New drugs usually cost more than established drugs, and their use may conflict with an unwillingness or inability to pay more (1,2). Clinical anesthesiology directors find that, of all their costs, those of anesthesia drugs and equipment are rising most rapidly (Robert L. Jones, Survey of The Association of Anesthesia Clinical Directors, personal communication, Fall 1992). Market research projects anesthesia drug sales in the United States to increase from

Combination of Δ9-Tetrahydrocannabinol with Oxymorphone or PentobarbitalEffects on Ventilatory Control and Cardiovascular Dynamics

1.1 billion in 1992 to

Increased Serum Bromide Concentration after Halothane Anesthesia in Man

2.1 billion in 1999, a 9.2% compound annual growth rate (3). Anesthesia practitioners select their techniques and drugs from choices with widely different costs. How anesthesiologists make their selections is unknown, but considering drug costs will become increasingly important (4-6). Recognizing this, a recent Rovenstine lecturer at the annual meeting of the American Society of Anesthesiologists advised attendees to ”be receptive to new information and technology” but warned that “perhaps the cost of the drug rather than modest circulatory responses deserves the greatest consideration” (7). People generally agree that health care and drugs are very expensive, but few practitioners know specific costs (8,9). To make cost-conscious drug decisions, anesthesiologists must know the cost of each drug and its alternatives. To control department drug expenses, anesthesiology directors must know how and why practitioners make specific drug selections and how cost information alters their selections. To begin answering these questions, we reviewed the costs of drugs used by anesthesiologists at West Virginia University (WVU) Hospitals and determined how an intensive cost education program affected the use of expensive drugs.

Cost containment in anesthesiology: A survey of department activities

Δ9-Tetrahydrocannabinol (THC), the active component of marijuana, was studied to determine whether it might be useful for preanesthetic medication. Ten healthy subjects received THC intravenously in logarithmically spaced incremental doses. Four subjects received a total cumulative dose of 135 μg/kg and four others, 201 μg/kg. Two of the ten subjects discontinued the study because of anxiety reactions. Ventilatory minute volume at a controlled elevated CO2 tension, 48 = 2 (SD) torr, changed minimally with THC, –0.49 1/min/50 per cent increase in dose. THC shifted the ventilatory response to CO2 2.7 torr dextrad at 20 1/min without a change in slope. Dose-related tachycardia was the most marked cardiovascular effect. Heart rates increased to more than 100/min in five of six subjects. Cardiac index increased from 4.04 = 0.62 1/min/m2before THC to 6.92 = 2.34 1/min/m2after 134 μg/kg. Mean arterial pressure increased slightly, and total peripheral resistance fell. The cardiovascular changes suggest betaadrenergic stimulation. Intense mental effects and anxiety prohibited higher THC doses.

Homicides Using Muscle Relaxants, Opioids, and Anesthetic Drugs: Anesthesiologist Assistance in Their Investigation and Prosecution

Inspired isoflurane concentration for anesthetizing 50 percent of adult albino mice (ED50) was 1.33 percent (1.20 to 1.47, 95 percent confidence interval). Ethanol anesthetizing dose was 5.09 (4.74 to 5.47) gm./kg. intraperitoneally (I.P.). Twenty, 39, and 79 percent of this ethanol anesthetic dose reduced isoflurane ED50 by 0, 8, and 70 percent, respectively. Thus, acute combinations of ethanol and isoflurane are more effective than either alone but less than the expected sum.Mice receiving no other fluid than 10 percent alcohol developed cross-tolerance to isoflurane. After 10 days of continuous alcohol ingestion, isoflurane ED50 increased to 1.54 (1.36 to 1.75) and after 20 days to 1.69 (1.55 to 1.84) percent. Combined with 2 and 4 gm./kg. of alcohol I.P., isoflurane ED50 in these mice decreased to 1.34 (1.26 to 1.42) and 0.73 (0.62 to 0.85) percent. Cross-tolerance acquired by these alcohol-consuming mice persisted through 55 days after stopping alcohol (ED50 1.65 percent), but returned to control values after 80 days (1.32 percent).

Market costs of short-term physician and nurse anesthesia services

Six hours after intravenous injection of morphine, 2 mg/kg, seven healthy adults received a ten-hour intravenous infusion of naloxone (3.66 μg/kg loading dose plus 3.66 μg/kg/hr), totaling 40 μg/kg. Immediately before administration of naloxone, resting minute ventilation (E) was 6.2 ± 0.4 (SE) l/mi