DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20180656

Drug utilization review of general anaesthetic agents in a tertiary care hospital

G. Gomathi, Ghanshyam Yadav, B. L. Pandey

Abstract


Background: Drug utilization review plays a key role in helping the healthcare system to understand, interpret and improve the prescribing, administration and use of medications. The principle aim of drug utilization review was to facilitate rational use of drugs, which implies the prescription of a well documented drug in an optimal dose on the right indication.

Methods: An observational study of anaesthetic practice was carried out in the department of Anaesthesiology in tertiary care hospital, Varanasi after approval from institutional ethical committee. The data of patients who underwent surgery under general anaesthesia were collected in predesigned patient profile form and were analyzed for drug utilization review.

Results: 110 patients were enrolled with mean age 35.30±17.99 years and mean weight 51.32±15.32kg. Laparoscopic cholecystectomy (43.63%), otorhinolaryngology surgeries (36.36%), cardiothoracic vascular surgery (4.54%), neurosurgery (4.54%) and other surgeries (10.93%) required general anaesthetic agents were reviewed. Propofol (93.63%) and etomidate (6.36%) were used for induction of anaesthesia. Propofol (45.45%), isoflurane (53.63%), sevoflurane (0.90%) were administered for maintenance of anaesthesia in various surgeries. Adverse outcomes observed were hypotension (7.27%), bradycardia (6.36%), hypertension (3.63%) and post operative nausea and vomiting (PONV) (2.72%).

Conclusions: Propofol is most commonly prescribed drug for induction of anaesthesia. Isoflurane is most commonly prescribed inhalational anaesthetic agent for maintenance of anaesthesia followed by Propofol. Hypotension is most common adverse outcome observed.


Keywords


General anaesthesia, Practice, Utilization review

Full Text:

PDF

References


American Society of Health-System Pharmacists. ASHP Guidelines on Medication-Use Evaluation published. 1996;53:1953-5.

Clark K, Lam LT, Gibson S, Currow D: The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomized control trials. Anaesthesia. 2009 Jun; 64(6):652-7.

Kain ZN, Mayes LC, Bell C, Hofstadter MB, Rimar S, Weisman S: Premedication in the United States: A Status Report. Anesth Analg. 1997;84:427-32.

Short TG, Chui PT. Propofol and midazolam act synergistically in combination. Br J Anaesth. 1991 Nov; 67(5):539-45.

Twyman RE, Rogers CJ, Macdonald RL. Differential regulation of gamma-aminobutyric acid receptor channels by diazepam and phenobarbital. Ann Neurol. 1989 Mar; 25(3):213-20.

Fujii Y. Prophylaxis of postoperative nausea and vomiting in patients scheduled for breast surgery. Clin. Drug Investig. 2006 Jan;26(8):427-37.

Mihara T, Tojo K, Uchimoto K, Morita S, Goto T. Reevaluation of the effectiveness of ramosetron for preventing postoperative nausea and vomiting: a systematic review and meta-analysis. Anesth. Analg. 2013 Aug;117(2):329-39.

Apfel CC, Kranke P, Katz MH, Goepfert C, Papenfuss T, RauchS, et al. Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting: a randomized controlled trial of factorial design. Br J Anaesth. 2002;88:659-68.

Joris LJ. Anaesthesia for laparoscopic surgery. In: Miller RD, ed. Anaesthesia. 5th Ed. Vol II. Philadelphia: Churchill Livingstone; 2000:2013.

Wang JJ, Ho ST, Uen YH, Lin MT, Chen KT, Huang JC, et al. Small - dose dexamethasone reduces nausea and vomiting after laparoscopic cholecystectomy: a comparison of tropisetron with saline. Anesth Analg. 2002;95:229-32.

Collins SJ, Robinson AL, Holland HF. A comparison between total intravenous anaesthesia using a propofol/alfentanil mixture and an inhalational technique for laparoscopic gynaecological sterilization. Eur J Anaesthesiol. 1996;13:33-7.

Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441-51.

Pollard BJ, Elliott RA, Moore EW. Anaesthetic agents in adult day case surgery. Eur J Anaesthesiol. 2003;20:1-9.

Sneyd JR, Carr A, Byrom WD, Bilski AJ. A meta-analysis of nausea and vomiting following maintenance of anaesthesia with propofol or inhalational agents. Eur J Anaesthesiol. 1998;15:433- 45.

Wang JJ, Ho ST, Tzeng JI, Tang CS. The effect of timing of dexamethasone administration on its efficacy as a prophylactic antiemetic for postoperative nausea and vomiting. Anesth Analg. 2000;91:136-9.

Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anaesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope. 2003;113(8):1369-73.

Tirelli G, Bigarini S, Russolo M, Lucangelo U, Gullo A. Total intravenous anaesthesia in endoscopic sinus-nasal surgery. Acta Otorhinolaryngol Ital. 2004;24(3):137-44.

Wormald PJ, van Renen G, Perks J, Jones JA, Langton- Hewer CD. The effect of the total intravenous anaesthesia compared with inhalational anaesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol. 2005;19(5):514-20.

Ankichetty SP, Ponniah M, Cherian V, Thomas S, Kumar K, Jeslin L, et al. Comparison of total intravenous anaesthesia using propofol and inhalational anaesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol. 2011;27(3):328-32.

Van Der Stelt M, Di Marzo, V. Cannabinoid receptors and their role in neuroprotection. Neuromol Med. 2005;7:37-50.

Wu J, Yao S, Wu Z. A comparison of anaesthetic regimens using etomidate and propofol in patients undergoing first-trimester abortions: double-blind, randomized clinical trial of safety and efficacy. Contracep. 2013;87:55-62.