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Pharmacoeconomics of Propofol Versus Thiopental for Induction Of 195 The Canadian Journal of Hospital Pharmacy- Volume 48, No. 4, August 1995 208 :y, Pharmacoeconomics of Propofol Versus Thiopental 1e, on for Induction of Anaesthesia in Short Procedures .ve si­ Sandy H.L. Hsu and Stephen J. Shalansky tre r1is :al ABSTRACT RESUME of This study compared the costs and benefits of using On a compare, au cours de cette etude prospective avec >rk propofol/fentanyl versus thiopental/fentanyl for cohorte qui a ete menee conjointement a un sondage lCY induction of anaesthesia in short procedures. A aupres des memes patients, les couts et les avantages de lCY prospective, cohort trial was conducted in conjunction /'association propofol/fentanyl a ceux de /'association with a patient survey. The study population included a thiopentallfentanyl pour /'induction de l'anesthesie dans ng consecutive sample of American Society of Anaes­ les interventions de courte duree. La population de l 'etude de thesiologists. Class I or II patients who underwent comprenait un echantillon consecutifde patients de classe I ou II de !'American Society ofAnesthesiologists qui ont ity short operative procedures and who were given one of the studied anaesthetic regimens. Insofl.urane/N20 was subi une breve operation et reru l'un des deux regimes me used for maintenance of anaesthesia in all cases. anesthesiques al'etude. Le maintien de l 'anesthesie etait el­ Propofol patients showed a significantly shorter time assure dans tousles cas par l'isojlurane et le N20. On a cs. to eye opening (p=0.0025 ); orientation to date ofbirth, note une diminution du temps d'ouverture des yeux ew place, and day of week (p=0.0002); time to (p = 0, 0025 ), du temps d 'orientation; evocation de la date )0- consciousness (p=0.0019); and time in recovery room denaissance, des lieuxetdujourde lasemaine(p = 0,0002), cal (p=0.013); but not time to tolerating 50 mL of oral du temps de reprise de conscience (0 = 0,0019) et du fluid (p=0.06). Nausea and vomiting occurred in 41% temps en salle de reveil (p = 0,013), mais non du temps an of thiopental patients and 19% of propofol patients pourgarder50mLdeliquide (p = 0,06), chezlespatients we (difference 22%; 95% C.I., -1% to 44%). Based on qui ont reru du propofol comparativement a ceux qui ont os- survey results, propofol patients subjectively reported reru du thiopental. Ces demiers Ont eprouve des nausees et des vomissements dans 4 I % des cas, comparativement 1da fewer side effects upon returning home and were able to resume daily activities earlier than thiopental a 19 % chez ceux qui avaient re9u du propofol (difference )ur patients. With the current staffing and patient load at de 22 %, intervalle de confiance de 95 %, ecart - I % a im­ our institution, an estimated 4.8 hours ofnursing time 44 % ). Se/on Les resultats du sondage, l'evaluation •act per day would be made available ifpropofol were used subjective des patients qui ont reru du propofol montre 1ar­ in place of thiopental for induction of anaesthesia in qu 'ils ont eu moins d' effets secondaires a leur retour a la ~l's these procedures. Ifpropofol were usedforall daycare maison et qu 'ils etaient capables de reprendre leurs surgery patients in our institution, the annual acquisi­ activites quotidiennes plus rapidement que ceux qui avaient tion cost is projected to be $60,33 I .28 versus $8,079.68 re9u du thiopental. Avec le personnel actuel et le nombre for thiopental. In conclusion, the use of propofol for de patients par in.firmier( ere) a notre etablissement, nous induction of anaesthesia in short procedures is more pourrions consacrer 4,8 heures du plus en temps de soins expensive than thiopental but may yield qualitative parjour si le propofol etait utilise a la place du thiopental advantages including more rapid recovery, less nausea pour !'induction de l'anesthesie dans Les interventions de and vomiting, and less burden on recovery room courte duree. Le cout d'achat annuel du propofol pour nursing staff. toutes les chirurgies d'un jour dans notre etablissement s'eleverait a 60 331,28 $ comparativement a 8 079,68 $ Key Words: pharmacoeconomics, propofol, thiopental. pour le thiopental. Le recours au propofol serait certes plus cher que /'usage du thiopental, mais ii concederait des avantages qualitatifs comme un reveil plus rapide, moins de nausees et de vomissements et moins d 'heures affectees en salle de reveil pour le personnel infirmier. Mots cles : pharmacoeconomie, propofol, Can J Hosp Pharm 1995; 48:208-213 thiopental. Sandy H.L. Hsu, B. Sc. (Phann.), is a Pharmacist, Department of Pharmacy, Vancouver Hospital and Health Sciences Centre, Vancouver, BC. At the time of the study, Ms. Hsu was a Pharmacy Resident at Lions Gate Hospital. Stephen J. Shalansky, Pharm.D., is Intensive Care Pharmacist, Education and Residency Coordinator, Department of Pharmacy, Lions Gate Hospital, and Clinical Assistant Professor, University of British Columbia, Vancouver, BC. Acknowledgments: The authors would like to acknowledge Linne Storey, Head Nurse of PAR and Daycare Surgery at Lions Gate Hospital, and her whole nursing staff for patiently preparing the charts and monitoring the patients. Ruth Milner of U.B.C. Hospital Shaughnessy Site Research Centre for her statistical work. Dr. Francis C. Ping, Head of Anaesthesia at Lions Gate Hospital, for his help and suggestions. Dr. Bruce Carlton of the Pharmacy Department at B.C. Children's Hospital for his advice on our protocol. Address Correspondence lo: Stephen Shalansky, Pharrn.D., Department of Pharmacy, Lions Gate Hospital, 231 East 15th Street, North Vancouver, B.C. V7L 2L 7. 209 The Canadian Journal of Hospital Phannacy - Volume 48, No. 4, aout 1995 Th Ta INTRODUCTION After the procedure, patients were marized to identify patients' sub­ Propofol' s rapid onset of action, short discharged to the post anaesthetic jective opinions regarding the agent duration of effect, and low incidence recovery unit (PAR) where nursing they received. Cost calculations were of side effects make it well suited for staff, who were unaware of the based on a propofol acquisition anaesthesia in short surgical pro­ anaesthetic agents used (anaesthetic cost of $8.88/200mg ampoule and cedures. While many studies have records were not available in PAR), $7 .88/2.5g vial ofthiopental. All costs demonstrated advantages of propofol recorded the patient's recovery time are in Canadian dollars. Annual cost for total anaesthesia, 1-11 propofol has from the end of surgery in terms of: projections assume 8726 patients per also been shown to reduce recovery time to spontaneous eye opening; year which was the number of daycare time and adverse effects when used orientation to date of birth, place, and operations done at our institution from strictly for induction.12-21 The high day of week; time when the patient April 1, 1992 to March 31, 1993. acquisition cost of propofol compared could tolerate 50 mL of clear oral to that of traditional anaesthetic agents fluid; time to consciousness defined RESULTS raises questions about its cost­ as achieving a Steward scale23 of 6, Fifty-two propofol and 22 thiopental effectiveness. Several authors have and total time spent in recovery. The patients were included over the three­ examined this issue;8-11 however, number of nausea and vomiting month study period. All patients these studies have all utilized regimens episodes experienced in PAR was also enrolled in the study were used in the in which propofol was used for both recorded. Patients were requested to data analysis. Patients received an induction and maintenance. We complete a questionnaire at approx­ average dose :!: SD of 2.29 :!: 0.45 designed this study to compare the imately 24 hours after their procedure mg/kg of propofol or 4.32 :!: 0.73 Ta costs and benefits of propofol and to document side effects experienced mg/kg of thiopental for induction, thiopental for induction ofanaesthesia at home including nausea, vomiting, and nitrous oxide in oxygen with in short procedures. Specifically we difficulty sleeping, headache, and isoflurane O to 4% for maintenance. looked at recovery times, incidence weakness. The survey also included Patients also received succinyl­ of nausea and vomiting, and nursing patients' estimates of when they were choline, vecuronium, and/or d-tubo­ hours per patient. Through a patient able to eat, resume leisure activities, curarine. Twenty-seven patients survey we also assessed side effects and return to work. Finally, the received 20 to 50 mg of lidocaine after discharge and the ability to questionnaire asked whether the prior to the propofol to reduce pain on resume daily activities. patient had undergone previous injection. surgery, whether they would choose The differences in patient age, METHODS the same anaesthetic if they required weight, sex, ASA grouping, fentanyl Propofol was compared to thiopental subsequent surgery, and asked for dose, and length of procedure are for induction of anaesthesia in short any additional comments. listed in Table I along with 95% daycare procedures in a prospective, A minimum required sample size confidence intervals. When these cohort study. The study included a of 14 patients per group was estimated group comparability parameters were consecutive sample of patients to detect a 15% difference in time to included as independent variables in undergoing short procedures between eye opening (ex = 0.05, ~ = 0.20) multiple regression analysis, none September21 andDecember24, 1992. based on recovery results from were associated with outcome (i.e., all Patients were included in the study if previous studies where propofol and recovery times studied). The pro­ wi they were classified as ASA I or II (as thiopental were used for induc­ portion of patients in the two study ve per the American Society of tion.3,6,7,12,19,24 The group compar- groups undergoing each procedure is de Anaesthesiologists guidelines22); ability and length of recovery times also listed in Table I.
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