A decision analysis of anesthesia management for cataract surgery.
A decision analysis of anesthesia management for cataract surgery.
复制标题
白内障手术麻醉管理决策分析
DOI：
10.1016/s0002-9394(01)01159-x
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发表时间：
2001
影响因子：
4.2
通讯作者：
Bass,EB
中科院分区：
文献类型：
--
作者：
Reeves,SW;Friedman,DS;Fleisher,LA;Lubomski,LH;Schein,OD;Bass,EB
比较权衡成本和偏好的各种麻醉管理策略的白内障surgery.METHODSSix策略，不同的镇静，局部麻醉，和监测方法，被选择进行比较。对于每种策略，对潜在并发症和转换为不同麻醉方法进行建模。一组精通白内障手术麻醉管理的文献和实践的医生和麻醉师为策略和潜在结局分配了偏好值（0至1量表）。概率估计值来自一项对19，557例白内障手术的研究和小组。费用估计数来自若干来源。模型进行了分析，以确定与最高的预期偏好和最低的预期costs.ESTSThe策略与最高的净偏好是静脉镇静与阻滞麻醉和麻醉师在场的情况下。该策略的预期净偏好比第二首选策略（口服镇静+阻滞麻醉和麻醉师随叫随到）的净偏好高19%（0.88比0.74），但每个病例的预期麻醉费用要高得多（324比42）。结果是敏感的合理的变化分配给六个初始管理策略的偏好值和局部与块anesthesies.CONCLUSIONThis分析的成本强调，成本和偏好是重要的考虑因素时，选择麻醉管理策略白内障手术。对于某些手术，可以节省大量的费用，以一个小的变化，在偏好。
PURPOSETo compare the trade-offs in cost and preference of various anesthesia management strategies for cataract surgery.METHODSSix strategies, differing in sedation, local anesthetic, and monitoring approach, were chosen for comparison. For each strategy, potential complications, and conversions to different anesthesia approaches were modeled. A panel of physicians and anesthetists, well versed in the literature and practice of the anesthesia management of cataract surgery, assigned preference values to the strategies and potential outcomes (0 to 1 scale). Probability estimates were obtained from a study of 19,557 cataract surgeries and from the panel. Cost estimates were derived from several sources. The model was analyzed to determine the strategies associated with the highest expected preference and lowest expected cost.RESULTSThe strategy associated with the highest net preference was intravenous sedation with block anesthesia and an anesthesiologist present throughout the case. The expected net preference for this strategy was 19% greater than the net preference for the next most preferred strategy, oral sedation with block anesthesia and an anesthesiologist on call (0.88 versus 0.74), but the expected anesthesia costs per case were much greater (324versus 42). Results were sensitive to plausible variation in the preference values assigned to the six initial management strategies and to the cost of topical versus block anesthesia.CONCLUSIONThis analysis emphasizes that cost and preference are important considerations when choosing an anesthesia management strategy for cataract surgery. For some surgeries, substantial cost savings may be available for a small change in preference.