Anesth Pain Med.  2017 Jan;12(1):23-27. 10.17085/apm.2017.12.1.23.

The economic evaluation of nitrous oxide in sevoflurane anesthesia

• Kim D
• Oh J
• Choi W
• Kwon YJ
• Ko S

• KMID: 2369661
• DOI: http://doi.org/10.17085/apm.2017.12.1.23

Abstract

BACKGROUND
Nitrous oxide (N2O) is much cheaper than recently introduced volatile anesthetics such as sevoflurane and desflurane, and can reduce the consumption of these anesthetics. The use of Nâ‚‚O is under current debate. The purpose of this study was to evaluate economic effect of 50% Nâ‚‚O during sevoflurane anesthesia in Korea.
METHODS
Seventy patients were randomly allocated to Group A or Group N. Anesthesia induction was performed using propofol, rocuronium, and 3-5% of sevoflurane with air (Group A) or 50% N2O (Group N). Fresh gas flow (FGF) was 6 L/min during induction, and 3 L/min for maintenance. Mean arterial pressure (MAP), heart rate (HR), bispectral index (BIS), and minimum alveolar concentration (MAC) were recorded. The consumption of sevoflurane was measured at every 10 minutes for the first 1 hour. The economic effect was analyzed based on the payment criterion of Korean National Health Insurance Service.
RESULTS
MAP, HR, BIS, and MAC showed no differences between the two groups. The sevoflurane consumptions for the first 1 hour were 39.2 ± 6.3 ml in Group A and 29.2 ± 4.9 ml in Group N (P < 0.01); and the Nâ‚‚O consumption was 93.7 ± 1.5 L in Group N. The total costs of inhaled anesthetics were 16,190 (14.8 USD) and 13,062 (12.0 USD) Korean won for the first 1 hour in Groups A and N, respectively.
CONCLUSIONS
Use of 50% Nâ‚‚O with 3 L/min FGF reduced the sevoflurane consumption by 25% and anesthetic cost by 20% for the first 1 hour.

Keyword

Economics; Nitrous oxide; Sevoflurane

MeSH Terms

Anesthesia*
Anesthetics
Arterial Pressure
Cost-Benefit Analysis*
Heart Rate
Humans
Korea
National Health Programs
Nitrous Oxide*
Propofol
Anesthetics
Nitrous Oxide
Propofol

Figure

• 

  Fig. 1 Data are expressed as mean ± SD. Minimum alveolar concentration is not different between two groups during anesthetic management. Group A: received air and oxygen with 0.5 of inspired fraction of oxygen. Group N: received nitrous oxide and oxygen with 0.5 inspired fraction of oxygen. IT-5: 5 min after intubation, and SI-10, SI-30, and SI-60: 10, 30, and 60 min after skin incision, respectively.

• 

  Fig. 2 Data are expressed as mean ± SD. Cumulative sevoflurane consumption is significantly different between the two groups after 10 min of sevoflurane administration. Group A: received air and oxygen with 0.5 of inspired fraction of oxygen. Group N: received nitrous oxide and oxygen with 0.5 inspired fraction of oxygen. *P < 0.05.

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