Influência da clonidina por via venosa no custo de anestesia com sevoflurano em cirurgias de ouvido médio em regime ambulatorial
Influence of intravenous clonidine in the cost of sevoflurane anesthesia for outpatient middle ear procedures
Renato Mestriner Stocche; Luís Vicente Garcia; Jyrson Guilherme Klamt; Marlene Paulino dos Reis; Daniela Rocha Gil; Karin Luiza Magno Mesquita
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: Clonidine is an a2-agonist which decreases intravenous and inhalational anesthetics consumption. This study aimed at evaluating the cost-benefit ratio of preanesthetic medication with intravenous clonidine for general anesthesia with sevoflurane in outpatient procedures.
METHODS: Forty five patients aged 15 to 52 years were included in this double-blind, randomized and placebo controlled study, and were distributed in 3 groups of 15: Group S (placebo), Group C3 (3 µg.kg-1 clonidine) and Group C5 (5 µg.kg-1 clonidine). Anesthesia was induced with sevoflurane, alfentanil (30 µg.kg-1) and pancuronium (0.08 mg.kg-1). The following parameters were recorded: incidence of complications, halogenate consumption and anesthesia duration, as well as phase I and II recovery time. Cost analysis has considered direct and indirect costs.
RESULTS: There were no differences among groups in demographics data, incidence of complications and phase I anesthetic recovery. Phase II anesthetic recovery was prolonged in Group C5 (p < 0.05). Sevoflurane consumption per minute of surgery was 0.54 ± 0.14, 0.33 ± 0.09 and 0.34 ± 0.13 in Groups S, C3 and C5 respectively (p < 0.05). Costs were approximately 35% lower in the clonidine groups.
CONCLUSIONS: Intravenous clonidine (3 µg.kg-1) decreases sevoflurane consumption without prolonging phase I recovery. Although decreasing sevoflurane consumption, 5 µg.kg-1 clonidine prolongs phase II recovery, thus being inadequate for outpatient procedures.
Keywords
References
Bain J, Kelly H, Snadden D. Day surgery in Scotland: patient satisfaction and outcomes. Qual Health Care. 1999;8:86-91.
Eger EI, White PF, Bogetz MS. Clinical and economic factors important to anaesthetic choice for day-case surgery. Pharmacoeconomics. 2000;17:245-262.
Howie MB, Hiestand DC, Jopling MW. Effect of oral clonidine premedication on anesthetic requirement, hormonal response, hemodynamics, and recovery in coronary artery bypass graft surgery patients. J Clin Anesth. 1996;8:263-272.
Friedberg BL, Sigl JC. Clonidine premedication decreases propofol consumption during bispectral index (BIS) monitored propofol-ketamine technique for office-based surgery. Dermatol Surg. 2000;26:848-852.
Eberhart LH, Novatchkov N, Schricker T. Clonidine compared to midazolam for intravenous premedication for ambulatory procedures: A controlled double blind study in ASA I patients. Anaesthesiol Intensivmed Notfallmed Schmerzthe. 2000;35:388-393.
Watcha M, White PF. Economics of anesthetic practice. Anesthesiology. 1997;86:1170-1196.
Chung F. Practical issues in outpatient anaesthesia: discharge criteria - a new trend. Can J Anaesth. 1995;42:1056-1058.
Szocik JF, Learned DW. Impact of a cost containment program on the use of volatile anesthetics and neuromuscular blocking drugs. J Clin Anesth. 1994;6:378-382.
Hawkes C, Miller D, Martineau R. Evaluation of cost minimization strategies of anaesthetic drugs in a tertiary care hospital. Can J Anaesth. 1994;41:894-901.
Kantor G, Chung F. Anaesthesia drug cost, control and utilization in Canada. Can J Anesth. 1996;43:9-16.
Broadway PJ, Jones JG. A method of costing anaesthetic practice. Anaesthesia. 1995;50:56-63.
Stocche RM, Garcia LV, Klamt JG. Comparação entre nifedipina por via sub-lingual e clonidina por via venosa no controle de hipertensão peri-operatória em cirurgias de catarata. Rev Bras Anestesiol. 2002;52:426-433.
