Cost-effectiveness of different methods of anesthesia for laparoscopic surgery: a prospective, multicenter,randomized, blind clinical study

Objective To compare the cost-effectiveness of inhalation of sevoflurane anesthesia,targetcontrolled infusion (TCI) of propofol anesthesia,and iv propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia for laparoscopic surgery in a prospective,multicenter,randomized,blinded clinical study.Methods Three hundred and thirty-six ASA physical status Ⅰ or Ⅱ patients from 4 centers,aged 18-64 yr,with body mass index of 16-30 kg/m2,scheduled for elective laparoscopic surgery,were randomly divided into 3 groups (n =112 each):inhalation of sevoflurane anesthesia group (group S) ; TCI of propofol anesthesia (group P) ; and iv propofol for induction of anesthesia-inhalation of sevoflurane for maintenance of anesthesia group (group PS).Anesthesia was induced with inhalation of 8 ％ sevoflurane in oxygen 8 L/min in group S,with TCI of propofol (target plasma concentration 4 μg/ml) in group P,or with iv injection of propofol 1.5 mg/kg in group PS.After loss of consciousness,fentanyl and vecuronium were injected intravenously in all the patients.The patients were endotracheally intubated and mechanically ventilated.PET CO2 was maintanted at 30-40 mm Hg.Anesthesia was maintanted with inhalation of sevoflurane (end-tidal concentration 0.8 MAC-1.5 MAC) in groups S and PS,or with TCI of propofol (target plasma concentration 3-6 μg/ml) in group P,and intermittent iv boluses of fentanyl and vecuronium were injected when needed in the three groups.Time for loss of consciousness,intubation time,time for recovery of spontaneous breathing,emergence time,extubation time,time for recovery of orientation,time for modified Aldrete score ≥ 9 and duration of stay in postanesthesia care unit and adverse effects during surgery were recorded.The costs of anesthetics were calculated.Results Compared with group P,the time for loss of consciousness,intubation time,time for recovery of orientation,and duration of stay in postanesthesia care unit were significantly shortened in group S,the time for loss of consciousness and intubation time were shortened in group PS,and the cost of propofol and/or sevoflurane,total costs of anesthetics,cost of propofol and/or sevoflurane per hour and total cost of anesthetics per hour were decreased in S and PS groups (P ＜ 0.05).Compared with group S,the time for loss of consciousness was significantly prolonged and the cost of propofol and/or sevoflurane,total costs of anesthetics,cost of propofol and/or sevoflurane per hour and total costs of anesthetics per hour were significantly decreased in group PS (P ＜ 0.05).There was no significant difference in the incidence of adverse effects among the three groups (P ＞ 0.05).Conclusion Induction with iv injection of propofol and maintenance with inhalation of sevoflurane is the most cost-effective method of anesthesia for laparoscopic surgery. Key words: Anesthetics, inhalation ;  Propofol;  Drug delivery systems ;  Cost-benefit analysis ;  Laparoscopic surgeries