Cost-effectiveness of propofol anesthesia using target-controlled infusion compared with a standard regimen using desflurane
Cost-effectiveness of propofol anesthesia using target-controlled infusion compared with a standard regimen using desflurane
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DOI：
10.1093/ajhp/59.14.1344
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发表时间：
2002-07-15
影响因子：
2.7
通讯作者：
Lienhart, AH
中科院分区：
文献类型：
--
作者：
Fombeur, PO;Tilleul, PR;Lienhart, AH
分析了靶控输注（TCl）丙泊酚麻醉与地氟醚麻醉维持的标准方案的成本效益。这项观察性研究包括100名年龄在18至75岁、美国麻醉医师协会身体状况为I或11的住院患者，这些患者计划进行持续时间不到4小时的耳科手术。患者接受两种治疗之一。地氟烷维持组接受丙泊酚2-4 mg/kg和舒芬太尼0.15-0.30 μ g（作为柠檬酸盐）/kg。A，在麻醉维持期间使用1 L/min的恒定新鲜气体流量。丙泊酚维持组在TCl丙泊酚基础上加输注舒芬太尼。以0.15-0.30 μ g/kg诱导麻醉。一名设盲评价者评估了所有患者的术后麻醉恢复情况。计算了术中和术后期间使用的药物和医疗器械的费用。有效性定义为术后无恶心呕吐（PONV），而每种手术的成本效益是每次无PONV发作的成本。每一程序的效率代表每一美元投资产生的效益。卡方检验和t检验、敏感性分析和logistic回归分析也进行了，检测到的唯一组间差异是在早期恢复期发生PONV的频率（地氟烷组11例，丙泊酚组2例）。在需要止吐抢救的患者中，地氟醚组9例，丙泊酚组仅2例（P < 0.05）。丙泊酚TO方案比地氟烷方案更昂贵（分别为每例患者45美元和28美元）（p < 0.001）。差异成本-效果比为94.7美元/次无PONV发作。两组患者术后24 h的PONV发生率和患者满意度相似，地氟醚标准方案比丙泊酚维持方案更经济有效。
The cost-effectiveness of propofol anesthesia using target-controlled infusion (TCl) versus a standard regimen using desflurane for anesthesia maintenance was analyzedThis observational study consisted of 100 inpatients 18 to 75 years old with an American Society of Anesthesiologists physical status of I or 11 who were scheduled for otological surgery lasting less than four hours. Patients received one of two treatments. The desflurane-maintenance group received propofol 2-4 mg/kg and sufentanil 0.15-0.30 mug (as the citrate)/kg. A, constant fresh gas flow of 1 L/min was used during maintenance of anesthesia. The propofol-maintenance group received,TCl propofol and an additional infusion of sufentanil. Anesthesia was induced with 0.15-0.30 mug/kg. One blinded evaluator assessed the postoperative recovery from anesthesia for all patients. The cost of drugs and medical devices used during the intra-operative and postoperative periods was calculated. Effectiveness was defined as the absence of postoperative nausea and vomiting (PONV), while the cost-effectiveness of each procedure was the cost per PONV-free episode. The efficiency of each procedure represented the production of effectiveness per dollar invested. Chi-square and t tests, sensitivity analysis, and logistic regression were also performed.The only intergroup difference detected was the frequency of PONV occurring in the early recovery phase (11 in the desflurane group versus 2 in the propofol group). Of those patients requiring antiemetic rescue, 9 were in the desflurane group and only 2 were in the propofol group (p < 0.05). The TO propofol regimen was more expensive than the desflurane regimen ($45 versus $28 per patient, respectively) (p < 0.001). The differential cost-effectiveness ratio was $94.7 per PONV-free episode. PONV 24 hours after surgery and patient satisfaction were similar between groups.A standard regimen of desflurane was more cost-effective than TO propofol for anesthesia maintenance in achieving PONV-free episodes.