Abstract
The choice of an anaesthetic agent is influenced by its cost. The use of a circle absorber system decreases the cost of the maintenance of anaesthesia with halogenated agents. Fast recovery and low incidence of postoperative nausea and vomiting are the main advantages of propofol. The cost of propofol can limit its use for the maintenance of anaesthesia except for short procedures. This prospective study compared in 50 ASA 1 and 2 patients the cost of anaesthesia with either propofol (group P, n = 25) or the association thiopentone-isoflurane administered with a rebreathing circuit (group I, n = 25). Patients were premedicated the evening before surgery with 2.5 mg lorazepam. Anaesthesia was induced with either propofol (2–3 mg · kg −1) or thiopentone (4–6 mg · kg −1) and maintained with either propofol (6–10 mg · kg −1 · h −1) in group P or isoflurane continuously injected as liquid in the expiratory limb of the circuit in group I. The side effects of anaesthesia and the delay of recovery and discharge from the recovery room were assessed. Peroperative cost of anaesthesia included nitrous oxide, isoflurane and i.v. agents, fluids volumes and disposable devices. The total cost of anaesthesia included also the recovery room stay. The mean duration of anaesthesia was not significantly different between the two groups (109.4 ± 7.1 min vs 107.3 ± 7.3 min group P vs group I). The delay of recovery (eyes opening) was shorter in the propofol group (14.4 ± 1.3 min vs 19.4 ± 1.4 min) as well as the delay of discharge from the recovery room (70 ± 4 min, vs 82.4 ± 4.6 min). Nausea or vomiting occurred in 2 group P patients and 6 group I patients. The cost of propofol anaesthesia was 1.7 times that of thiopentone-isoflurane (305.7 ± 13.3 FF vs 179.6 ± 8.9 FF, p < 0.001). This additionnal cost of propofol is not excessive in comparison with the cost of surgery and is out-weighted by the advantages of this drug. When the use of propofol for maintenance of anaesthesia is considered, the cost should not be a contraindication to this technique.
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