A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery

Citation
Ra. Beers et al., A comparison of the cost-effectiveness of remifentanil versus fentanyl as an adjuvant to general anesthesia for outpatient gynecologic surgery, ANESTH ANAL, 91(6), 2000, pp. 1420-1425
Citations number
13
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
91
Issue
6
Year of publication
2000
Pages
1420 - 1425
Database
ISI
SICI code
0003-2999(200012)91:6<1420:ACOTCO>2.0.ZU;2-X
Abstract
The unique pharmacokinetic properties of remifentanil make it a potentially useful adjuvant during general anesthesia for ambulatory surgery. Fentanyl , inexpensive and easy to administer, is the most common opioid used for th is purpose. As an adjuvant to general anesthesia for outpatient gynecologic surgery, we questioned if remifentanil was cost-effective as an alternativ e to fentanyl. Thirty-four patients undergoing gynecologic laparoscopy or h ysteroscopy were prospectively and randomly assigned to a standard practice (n = 18) or a study (n = 16) group. Standard practice patients received fe ntanyl (3 mug/kg) before induction; study patients received remifentanil by continuous infusion (0.5 mug.kg.min(-1) at induction, then 0.2 mug.kg.min( -1)). Sevoflurane was titrated to a Bispectral index value of 40-55. We inv estigated recovery profiles, patient and health care professional satisfact ion, and drug costs. The incidence of rescue antiemetic treatment (2 of 16 vs 8 of 18; P = 0.013) and the nausea visual analog scale scores during sec ond stage recovery (0.2 vs 0.6; P = 0.044) were more frequent in the study group. However, the incidence of intraoperative adverse events and other po stoperative sequelae, recovery times, pain and nausea visual analog scale s cores, opioid analgesic dosage requirements in the postanesthetic care unit , and satisfaction survey responses were similar between groups. Perioperat ive drug costs per patient were $17.72 more in the remifentanil (vs fentany l) group.