Abstract
Purpose
A randomized, blinded clinical trial was undeitaken to compare recovery charactenstics and cost-benefits associated with three general anaesthetic techniques for arthroscopic knee surgery in an ambulatory care setting.
Methods
Ninety three. ASA Physical Status l-ll patients were randomly allocated to receive one of three types of general anaesthesia: isoflurane /fentanyl/N2O (Group INH); alfentanil/N2O (Group BAL); or propofol/alfentanil/O2 (Group TIVA). Postoperative recovery profiles were evaluated at 30, 60, 90 and 120 min after emergence from anaesthesia, and direct and indirect costs of each anaesthetic were compared.
Results
The most rapid emergence was observed in Group BAL (2.2 ± 1.5 min, P< 0.000l compared with groups INH and TIVA), although the incidence of post-operative nausea and vomiting was also highest in this group (P = 0.02 compared with groups INH and TIVA). However, overall patient satisfaction, and mean times to discharge from the Post Anaesthesia Recovery Unit and hospital, were rapid and similar in all three groups. During anaesthesia which lasted 40–45 min, nearly a four-fold difference was observed in the direct costs of anaesthetic drugs: $16.4 ± 4.4 (Group INH). $45.3 ± 11.4 (Group BAL) and $63.4 ± 17.9 (Group TIVA, P < 0.001 between groups): while indirect costs were similar.
Conclusions
For arthroscopic knee surgery. INH anaesthesia with isoflurane/fentanyl/N2O is associated with similar hospital discharge times, and comparable levels of patient satisfaction as either BAL or TIVA. While indirect costs were similar, lower direct costs suggest that there may be a pharmacoeconomic benefit associated with the use of a “standard” isoflurane/fentanyl/N2O anaesthetic in certain day care surgery procedures.
Résumé
Objectif
Cette étude clinique aléatoire et à l’aveugle visait à comparer les caracténstiques de la récupération et les valeurs coûts/bénéfices associées à trois techniques d’anesthésie générale réalisées pour la chirurgie arthroscopique du genou dans un encadrement de chirurgie ambulatoire.
Méthodes
Quatre-vingt-treize patients ASA I et II étaient répartis aléatoirement pour recevoir une des trois techniques d’anesthésie générale suivantes: isoflurane/fentanyl/N2O (groupe INH); alfentanil/N2O (groupe BAL): ou propofol/alfentanil (groupe TIVA). Le profil de la récupération postopératoire était évalué à 30, 60, 90 et 120 min après le réveil et les coûts directs et indirects de chaque technique étaient comparés.
Résultats
Un réveil plus rapide était observé dans le groupe BAL (2,2 ± 1.5 min, P < 0,0001) comparativement au groupe INH et TIVA, mais, dans ce groupe, l’incidence des nausées et des vomissements postopératoires était aussi la plus élevée (P=0,02) comparativement aux groupes INH et TIVA. Cependant, la satisfaction générale du patient était élevée et la durée moyenne du séjour à l’unité des soins postanesthésiques et à l’hôpital étaient identiques pour les trois groupes. Pendant l’anesthésie, qui durait de 40 à 45 min, on a constaté que les coûts directs des agents quadruplaient selon la technique; 16.4 ± 4.4 (groupe INH), 45.3 ± 11,4 (groupe BAL) et 63.4 ± 7,8 (groupe TIVA, P< 0,001 entre les groupes), alors que les coûts indirects demeuraient les mêmes.
Conclusion
Pour la chirurgie arthroscopique du genou, l’anesthésie INH à l’isoflurane/fentanyl/N2O est associée à la même durée de séjour à l’hôpital et, pour le patient, à un degré de satisfaction comparable aux techniques BAL et TIVA. Alors que les coûts indirects sont les mêmes, des coûts directs inféneurs suggèrent que, sous l’aspect pharmacologique, l’utilisation d’une l’anesthésie standard isoflurane/fentanyl pourrait être avantageuse pour certaines interventions chirurgicales ambulatoires.
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Alhashemi, J.A., Miller, D.R., O’Brien, H.V. et al. Cost-effectiveness of inhalational, balanced and total intravenous anaesthesia for ambulatory knee surgery. Can J Anaesth 44, 118–125 (1997). https://doi.org/10.1007/BF03012998
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DOI: https://doi.org/10.1007/BF03012998