248 ANAESTH, PAIN & INTENSIVE CARE; VOL 17(3) SEP-DEC 2013 ORIGINAL ARTICLE Anesthetic maintenance with propofol infusion is less expensive per minute of surgery than sevolurane or deslurane Brandon A. Van Noord, MD*, John Lee, MD*, Yao Ping Zhang, MD*, Philip Lumb, MB*, Valdimir Zelman, MD, PhD*, Frederico Bilotta, MD** and Eugenia Ayrian, MD* *Department of Anesthesiology, Keck Medical Center, University of Southern California, Los Angeles CA 90033 (USA) **Department of Anesthesiology, Critical Care & Pain Medicine, Sapienza University, Rome (Italy) Correspondence: Brandon A. Van Noord, MD, Department of Anesthesiology, LAC + USC Medical Center, 1200 N. State Street, IPT, Room C4E100, Los Angeles CA 90033 (USA); E-mail: brandon.vannoord@gmail.com ABSTRACT Objective: Cost comparison between three common anesthetic agents. Design: Retrospective analysis. Patients had been randomized to anesthetic maintenance with either deslurane, sevolurane, or propofol. Setting: Operating room in an academic medical center Patients: 103 patients undergoing general endotracheal anesthesia. Patients were ASA class I-III and between 18 and 75 years old. Cardiac, Neurologic, and regional cases were excluded. Outcome Measures: Volatile anesthetic cost was determined using the following formula: Cost = [(concentration) (FGF)(duration)(MW)(cost/ml)]/[2412)(D)]. To determine propofol cost, average infusion rate (mcg/kg/min.), patient weight, and duration were measured. Cost for each agent was then divided by surgical time to compare the results on a cost/min. basis. Results: Per minute of surgery, propofol was the least expensive agent for anesthetic maintenance at $0.12/min. Sevolurane cost $0.18/min and deslurane cost $0.48/min. The differences between all three agents were statistically signiicant (p <0.05). Propofol maintenance was associated with a higher intra-operative fentanyl dose. The average fentanyl dose in the propofol group was 468 mcg, sevolurane was 321 mcg, and deslurane was 284 mcg. There was no association between intra-operative fentanyl dose and anesthetic maintenance cost per minute of surgery. Surgical time did not signiicantly differ between the three groups and averaged over three hours. Conclusion: Anesthetic maintenance with propofol may help peri-operative physicians deliver care in the most cost effective manner possible. Key words: Propofol; Sevolurane; Deslurane; Cost; Anesthetic maintenance Citation: Van Noord BA, Lee J, Zhang YP, Lumb P, Zelman V, Bilotta F, Ayrian E. Anesthetic maintenance with propofol infusion is less expensive per minute of surgery than sevolurane or deslurane. Anaesth Pain & Intensive Care 2013;17(3):248-251 INTRODUCTION The surgical environment has transformed from primarily inpatient to primarily outpatient. To maximize return on capital investment, ambulatory surgery as a percent of total surgery has increased from 15% in 1980 to 75% in 2003. 1 While the cost of anesthetic maintenance for an individual case may be low, in aggregate anesthetic agents account for a substantial portion of the overall pharmacy budget: 5-13% with institutional costs increasing along with surgical volume. 2 In the United States, the recent passage of the Affordable Care Act will increase cost containment efforts throughout the entire healthcare system. 3 Increased inancial pressures should incentivize hospitals, pharmacies, and physicians to cooperate with the aim of improving quality and slowing spending growth. 4 Medication acquisition cost varies between institutions. Price is determined by a negotiated contract between hospitals and pharmaceutical companies with discounts