Substitution of isoflurane by sevoflurane toward the end of long surgeries is cost effective

The lower solubility of sevoflurane allows a more rapid emergence from anesthesia than after anesthesia with more soluble but less expensive anesthetic isoflurane. Cost control in anesthesia is no longer an option: it is a necessity. We substitute sevoflurane for isoflurane toward the end of anesthesia lor operations longer than 3 hours in an attempt to combine the cost effectiveness of isoflurane with rapid emergence from sevoflurane. Sixty patients undergoing long abdominoplastic and ENT surgeries were randomly equally divided into three groups: group I [isoflurane group], group II [crossover group] where isoflurane was substituted by sevoflurane during the last 30 minutes of the operation and group III [sevoflurane group]. A fresh gas flow of 2 L/min as 60% N2O in 02 was used for maintenance of anesthesia. Consumption of volatile anesthetics was measured by weighing the vaporizers with a precision weighing machine and recovery variables were recorded. The times for spontaneous breathing, times to opening eyes, squeeze a finger on command, times for extubation, orientation, times to read Aidrete score >/= 9 and time to discharge from PACU: all these times were significantly longer in isoflurane group than the crossover and sevoflurane groups and no significant difference between crossover and isoflurane groups. Cost was significantly higher in sevoflurane group [1.242 EP per minute anesthesia]. The costs among the other two groups did not differ significantly [0.319 EP/min for isoflurane group and 0.344 EP/min for crossover group]. So sevoflurane based anesthesia was associated with the highest costs and faster recovery. In conclusion, by changing from isoflurane to sevoflurane toward the end of long anesthesia, we can accelerate recovery and decrease its expenditures without compromising the measured patient outcomes

approach to minimize perioperative hypothermia and its complications

During general anesthesia there is marked decrease in energy expenditure and heat generation, in addition, central thermoregulatory function is impaired Postoperatively, hypothermicpatients are uncomfortable and at risk of developing several hypothermic related complications such as shivering, ischemic cardiac events and decreased resistance to wound infections. We investigated the effect of I V infusion of a balanced mixture of ammo acids in prevention of perioperative hypothermia and its complications. Forty patients undergoing major abdominal surgery were randomly assigned to either an amino acid [a a] group or a control group. Patients in the a. a group received mixture of 19 amino acids I' V at a rate of 100 ml/h given 1h before induction and continuing for 3h after induction. The control group received Ringer's solution. During the perioperative period we recorded heart rate, arterial blood pressure, SO2, end tidal CO2 and rectsl core temperature Plasma norepinephrine was assayed before induction and after surgery On recovery the patients were observed for shivering and were asked about cold feeling. The mean duration of stay in PACU and hospital stay duration were recorded The surgical wounds were evaluated The mean core body temperature at the end of surgery and at the discharge from the PACU were significantly lower in the control group than the a a group The mean heart rate and arterial blood pressure were significantly higher in the control group. The incidence of postoperative shivering and cold feeling was higher in the control group than the a a group. The mean plasma concentration of norepinephrine was significantly higher in the control groupr. The mean duration of stay in the PACU and duration ofthe hospital stay were significantly longer in the control group than the a.a. group. In conclusion it was found that the infusion of amino acids to anesthetized patients will induce thermogenesis preventing perioperative hypothermia and significantly decreases the sympathetically mediated dynamic and hormonal response to hypothermia during recovery from anesthesia It decreases also significantly the postoperative shivering and cold feeling of the patient. Amino acid infusion enhances also recovery and shortens the hospital stay