Due to the funding limitation in government community
health protection schemein 2014, quality control and medical
cost are the important factor to be concerned. Therefore the application in pharmacoeconomic study in choosing the effectiveand efficient medication has an important roles.
Objective : To know the cost-minimalization analysis general
anesthesiabetween propofol target controlled infusion and anastehsia inhalationin major operationpatient at Sanglah hospital.
Methods : A Consecutive Randomized Controlled Trial study
of 40 patient that undergo a major operation at central operating theather Sanglah hospital, divided into two groups. Group A is patient with propofol target controlled infusion and group B is patient with anesthesia inhalation isoflurane. The collected data wasstatistically analyzed with Shapiro Wilk, Lavene Test and independent sample T-test (P < 0.05).
Results : In this study, the drug usage ratio perminute in group
A is 8,54 mg (±2,04 mg) and 0,42 ml (±0,09 ml) in group B. The drug cost in general anesthesia group A is Rp. 800,85 (±Rp. 127,99) per minute and in group B isRp.1.266,32 ( ± Rp. 227,26) per minute (P < 0.001).
Conclusion : the cost-minimalization analysis in general
anesthesia drug using propofol TCI siginificantly cheaper than anesthesia inhalation isofluran. Keywords: cost-minimalization analysis, general anesthesia drug, TCI propofol,isoflurane
Absalom, A. R., Sutcliffe N., Kenny, G. N., (2002), Closed-
loop control of anesthesia using Bispektral index: performance assessment in patients undergoing major orthopedic surgery under combined general and regional anesthesia. Anesthesiology. ;96:67-73.
Andrade, J., Englert, L., Harper, C., Edwards, N. D., (2001),
Comparing the effects of stimulation and propofol infusion rate on implicit and explicit memory formation. Br J Anaesth .;86:189-95.
Ashraf, A., Dahaba., (2005), Different Condition that could
Result in the Bispektral Index Indicating an Incorrect Hypnotic State, Anesthesia Analgesia;101:765-73.
Bertram G.Katzung, (2004), Basic and Clinical
Pharmacology, 9th ed., p.413-414.
Billard, V., Constant, I., (2000). Automatic analysis of
electroencephalogram: what is its value in the year for monitoringanesthesia depth? Ann Fr Anesth Reanim. 2001;20:763-85 Boldt, J., Jaun, N., Kumle, B., Heck, M., Mund, K., (1998), Economic considerations of the use of anesthetics: a comparison of propofol, sevofluran, desfluran, and isoflurane. Anesthesia and Analgesia.;86:504-509. Bower, A, L., Ripepi, A., Dilger, J., Boparai, N., Brody, F, J., Ponsky, J,L., (2000) Bispektral index monitoring of sedation during endoscopy. Gastrointest Endosc.;52:192-6.
Bruhn, J., Bouillon, T, W., Shafer, S, L., (2000) Bispektral
index (BIS) and burst suppression: Revealing part of the BIS algorithm. J Clin Monit.;16:593-596.
Chernin, E, L., (2004), Pharmacoeconomics of inhaled
anesthetic agents: considerations for the pharmacist. American Journal of Health-System Pharmacy.;61(suppl 4):S18-S22. Coste, C., Guignard, B., Menigaux, C., Chauvin, M., (2000), Nitrous oxide prevents movement during orotracheal intubation without affecting BIS value.Anesth Analg.;91:130- 5.
Crozier, T. A.,Kettler, D., (1999) "Cost effectiveness of
general anaesthesiology ", British Journal of Anaesthesiology,ed 1,volume 83, number 4, Department of Anaesthesiology ,Emergency and Intensive Care Medicine University of Gottingen Medical School, Germany,Gottingen.
Dion, P., (1992), The cost of anaesthetic vapors. Canada
Journal of Anaesthesia.;39(6):633.
Edward, Morgan,Jr., Maged, S., Mikhail et al.,(2006), Clinical
Anesthesiology, 4th ed ;8:200-202.
Eger, E.I., (2010), Inhaled anesthetics: uptake and
Eger, E.I., (2010), Cost in several flavors. International
Anesthesia Research Society.;110(2):276-277.
Eger, E.I., (2002), A brief history of the origin of minimum
alveolar concentration (MAC). Anesthesiolog ;96(1):238- 239. Friedberg, B.L., Sigl, J.C., (2000), Clonidine premedication decreases propofol consumption during Bispektral index (BIS) monitored propofol-ketamine technique for office -based surgery. Dermatol Surg.;26:848-52.
Golembiewski, J., (2010), Economic considerations in the use
of inhaled anesthetic agents. American Journal of Health- System Pharmacy ;67:S9-S12.
Hasani, Antigona., Jashari, H., Valbon, Gashi., Albion, D.,
Propofol and postperative pain: systemic review and meta- analysis. Available from: http://www.intechopen.com/book/pain-management-current- issues-and-opinions/propofol -and-postoperative -pain- review-and-meta-analysis. Honan, D.M., Breen, P.J . et al.,(2002), Decrease in Bispektral Index Preceding IntraoperatifHemodynamic Crisis Evidence of Acute Alteration of Propofol Pharmacokinetic, Anesthesiology ;97:1303-5.
Islam, S., Jain, P.N., (2004),Post-Operative Nausea And
Vomiting (PONV) : A Review Article. Indian J Anaesth. ; 48 (4) : 253-8. Iswahyudi, Sinardja K., Senapathi T.G.A., “Analisis Biaya Periode Intraoperatif Anestesi Intravena Total Propofol Target Controlled Infusion (TCI) dengan Anestesi Inhalasi Sevoflurane pada Pasien Operasi Bedah Mayor Onkologi di RSUP Sanglah Tahun 2013”. Bagian Anestesiologi dan Terapi Intensif. Fakultas Kedokteran Universitas Udayana.
Johansen, J. W., Sebel, P. S., (2000), Development and
Clinical Application of Electroencephalographic Bispectrum Monitoring, Anesthesiology ;93:1336-44.
Katzung, B. G., (2010), Basic and Clinical Pharmacology, 9th
ed., p.413-414.
Latief, S. A., Suryadi, K. A ., Dachlan, M. R., (2002),
Anestetik Inhalasi dalam buku: Petunjuk Praktis Anestesiologi edisi kedua, hal 48-64, penerbit Bagian Anestesiologi dan Terapi Intensif FKUI , Jakarta. Lockwood, G. G., White, D.C., (2001), Measuring the costs of inhaled anaesthetics. British Journal of Anaesthesia.;87(4):559-563
Loke, J., Shearer, W. A. J., (1993), Cost of anaesthesia.
Canada Journal of Anaesthesia;40(5):472-474.
Mangku, G., (2002), Diktat Kumpulan Kuliah Buku I,
penerbit Bagian Anestesiologi dan Reanimasi FK UNUD, hal 74-84, Denpasar.
Mangku, G., (2000), Anestesi Inhalasi dalam buku Standar
Pelayanan dan Tatalaksana Anestesia-Analgesia dan Terapi Intensif, hal 28, penerbit Bagian Anestesiologi dan Reanimasi FK UNUD/RSUP Sanglah Denpasar.
McGregor, M., (2003),Cost-utility analysis: use QALYs only
with great caution. Can Med Ass J ;168:433-434. Meyer, T., (2010), Managing inhaled anesthesia: challenges from a health-system pharmacist’s perspective. American Journalof Health-System Pharmacy;67:S4-S8.
Naidoo, D., (2011), Target Controlled Infusions, University of
Kwazulu-Natal.
Newson, C., Victory, R., White, P. F., (1995),Comparison of
Propofol Administration Techniques for Sedation During Monitored Anesthesia Care. Anesthesia Analgesia;81:486-9.
Odin, I., Feiss, P., (2005), Low flow and economics of
inhalational anesthesia. Balliere’s Best Practice in Clinical Anesthesiology;19:399-413.
Pemberton, P. L., Dinsmore, J., (2002), Bispektral index
monitoring during awake craniotomy surgery. Anaesthesia :57;1243-1245.
Rascati, K. L., (2009), Essentials of Pharmacoeconomics.
Philadelphia: Lippincott William & Wilkins; 45-58.
Renna, M., Venturi, R., (2000), Bispektral index and
anaesthesia in the elderly. Minerva Anestesiol;66:398-402. 78. Scott, D., Kelley., (2004), Monitoring Level of Consciousness during Anesthesia and Sedation. A Clinician’s Guide to the Bispektral Index. ASPECT medical system USA.
Struys, M. M., De Smet, T., Versichelen, L. F., Van De
Velde, S., Van den Broeck, R., Mortier, E. P., (2001), Comparison of closed-loop controlled administration of propofol using Bispektral Index as the controlled variable versus “standard practice” controlled administration. Anesthesiology ;95:6-17.
Stoelting, R. K., Hiller, S. C., (2006), Nonbarbiturate
Intravenous Anesthetic Drugs. In: Pharmacology & Physiology in Anesthetic Practice. 4th Edition. Philadelphia: Lippincott William & Wilkins; 155-63.
Sugiarto, Adhrie., (2012), Panduan praktis total intravenous
Regional Versus General Anesthesia in Surgical Patients With Chronic Obstructive Pulmonary Disease: Does Avoiding General Anesthesia Reduce The Risk of Postoperative Complications?