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Inadequate depth of anaesthesia is associated with significant morbidity.
The findings of the present randomised trial determined that the use of
BIS and TOF monitoring have the potential to hasten postoperative recovery, and
it can also decrease the total cost of anaesthesia drugs.
Inadequate depth of anaesthesia is associated with
significant morbidity. The risk of complications and cost of anaesthesia can
increase with a rise in the required depth of anaesthesia. It can also lead to
prolonged recovery time and increased health-care costs. Inadequately light anaesthesia can maximize
the risk of intraoperative awareness, whereas incomplete reversal of
neuromuscular blockade results in residual neuromuscular weakness with
undesirable consequences. Various monitoring techniques can be helpful in
reducing complications of anaesthesia in the perioperative period. Only a few
studies published on simultaneous monitoring of depth of anaesthesia with
bispectral index (BIS) and neuromuscular blockade with train-of-four (TOF). The cost of these monitoring techniques influence the
treatment methods, and it is vital to managing the costs of these techniques to
reach maximal gains. The cost of a particular activity, treatment, working
process constitutes fixed and variable parts.
There must be a balance between the values of various agents,
pharmacodynamic advantages of anaesthetics (e.g. sevoflurane, propofol),
perioperative complications, and patient monitoring techniques. Numerous
studies have evaluated the cost-effectiveness of anaesthetic measures, but
there is a lack of evidence that can depict the profitability of BIS and
TOF monitoring associated with
anaesthesia.
Rationale behind research
Objective
The study aimed to compare drug dosage and total
cost (direct plus additional fees) of anaesthesia maintained with sevoflurane
or propofol with or without the combination of BIS and TOF monitoring,
respectively.
Study outcomes
·
Time Points: NA
Outcomes
Baseline: There were no significant differences observed at baseline
Study outcomes:
The results of the
study indicated a lower drug cost of sevoflurane and propofol anaesthesia with
BIS and TOF as compared to sevoflurane and propofol anaesthesia without BIS and
TOF monitoring. The total cost of anaesthesia drug was reduced with BIS
monitoring, but there was a rise in the total cost of anaesthesia. There was no
effect of TOF monitoring observed the value of atracurium during anaesthesia.
The lower price of propofol as induction agents on BIS monitoring depicts that
depth of anaesthesia can cause a reduction of dose during the induction of
anaesthesia. The lower hourly cost of fentanyl during anaesthesia in groups
SEVO and SEVO+ compared to PROP, and PROP+ was due to the analgesic effect of
sevoflurane rather than the use of depth of anaesthesia monitoring. It can be
explained by the similar patient (e.g. age, body weight) and operational
characteristics (the type of surgery, time of surgery and anaesthesia) in all
groups. Besides, the cost associated with propofol anaesthesia with BIS
monitoring was higher as compared to Sevoflurane anaesthesia without BIS
monitoring (group SEVO). The reason
behind this was the higher cost of intravenous technique and the disposable BIS
sensor. These results were not contradictory to previous studies, and this may
occur due to the small number of recruited patients. The time of extubation
become shorter when BIS and TOF monitoring was employed. The time to MAP
restoration was independent of BIS monitoring. In summary, it was concluded
that anaesthesia guided by BIS and TOF provides faster postoperative recovery
with lower drug cost and higher disposable costs.
Bocskai et al. BMC Anesthesiology (2018) 18:100
Cost-effectiveness of anesthesia maintained with sevoflurane or propofol with and without additional monitoring: a prospective, randomized controlled trial
Timea Bocskai et al.
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