Pharmacoeconomics of desflurane based minimal flow anesthesia for different durations of surgery

Habib M. R. Karim, Mohd Yunus, Laltanpuii Sailo, Stevie J. N. Sangma, Newstar Syiemiong


Background: Desflurane is relatively newer volatile anesthetic in clinical practice with many advantages. Unfortunately, it is comparatively costlier. The present observational study is aimed to evaluate the consumption pattern and cost of Desflurane based minimal flow anesthesia with regards to different durations of anesthesia.

Methods: Twenty adults of American Society of Anesthesiologists’ class I and II of either sex were enrolled for the study with informed consent during November 2015 to January 2016. Anesthesia was performed using Intermed Penlon sigma Alfa Desflurane vaporizer and Penlon Prima SP2 workstation. Age and opioid compensated minimum alveolar concentration was fixed for each patient and was monitored using Penlon SP M8 monitor and its attached anesthesia gas monitoring system. Bispectral index was used in affordable patients to monitor depth of anesthesia. Data of Desflurane consumption was collected from the digital numerical display on the vaporizer screen. Statistical analysis was done using INSTAT software and cost was calculated from maximum retail price.

Results: Data from 20 patients consisting 60% male (mean + standard deviation age of 39.8 + 16.9 years and weight of 59.7 + 12.52 kilograms) were analyzed. Gender had no effect on consumption of Desflurane. Older patients (>60 years) consumed less than the younger (p<0.05). Mean Desflurane consumption was highest during first 5 minute (6.2 ml) and followed decreasing trend till 45 minute of anesthesia (p<0.05) followed by a near steady consumption. Cost of Desflurane reduced from Indian Rupees 22/minute for 15 minute anesthesia to Indian Rupees 6/minutes for 3 hours anesthesia.

Conclusions: Desflurane consumption and cost do not depend on sex but on age, flow and time. It becomes more cost-effective for relatively longer duration of minimal flow anesthesia.


Cost pharmacotherapy, Desflurane consumption, Minimal flow desflurane anesthesia, Pharmacoeconomics

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Kapoor MC, Vakamudi M. Desflurane - Revisited. J Anaesthesiol Clin Pharmacol. 2012;28:92-100.

Jakobsson J. Desflurane: a clinical update of a third-generation inhaled anaesthetic. Acta Anaesthesiol Scand. 2012;56:420-32.

Eger EI II. Age, minimum alveolar anaesthetic concentration and minimum alveolar anesthetic concentration–awake. Anesth Analg. 2001;93:947-53.

Sebel PS, Glass PS, Fletcher JE, Murphy MR, Gallagher C, Quill T. Reduction of the MAC of desflurane with fentanyl. Anesthesiology. 1992;76:52-9.

Eger EI 2nd. New inhaled anesthetics. Anesthesiology. 1994;80:906-22.

E Virginia. Pediatric Focused Safety Update: Suprane ® (desflurane). U.S. Food and Drug Administration. June 21st, 2010. Available from: Cited on 21 February 2016.

Weinberg L, Tay S, Aykanat V, Segal R, Tan CO, Peyton P, McNicol L, Story DA. Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals. Anaesth Intensive Care. 2014;42(5):579-83.

American College of Physicians. Controlling Health Care Costs While Promoting The Best Possible Health Outcomes. Philadelphia: American College of Physicians; 2009: Policy Monograph. Available from: controlling_healthcare_costs_2009.pdf. Cited on 28th March 2016.

Nunn G. Low-flow anesthesia. Contin Educ Anaesth Crit Care Pain. 2008;8:1-4.

Elmacioglu MA, Goksu S, Hasan Kocoglu H, Oner U. Effects of flow rate on hemodynamic parameters and agent consumption in low-flow desflurane anesthesia: An open-label, prospective study in 90 patients. Curr Ther Res Clin Exp. 2005;66(1):4-12.

Biro P, Kneschke O, Theusinger O M. Accuracy of calculated volatile agent consumption from fresh gas content. Acta Anaesthesiol Scand. 2015;59(5):619-24.

Varkey J, Welliver M. Debunking Volatile Anesthetic Cost Myths Between Sevoflurane and Desflurane. Anesthesia E Journal. 2014;1(2). Available from: index.php/ aej/article/view/6 [cited on 2nd March 2016].

Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2007;4:CD003843-CD003843.

Avidan MS, Zhang L, Burnside BA, Finkel KJ, Searleman AC, Selvidge JA, et al. Anesthesia awareness and the bispectral index. N Engl J Med. 2008;358:1097-108.