Evidence Based Practice and Quality Assurance
Background and Goal of Study: Neuromuscular blocking agents (NMBAs) represent a major component of anaesthesia costs (1). The aim of this study was to investigate the cost-effectiveness of commonly used NMBAs administered as equipotent boli or infusions.
Materials and Methods: Eighty ASA III patients undergoing thoracic surgery were randomly selected to receive atracurium, cisatracurium, mivacurium or rocuronium. The neuromuscular block was monitored by accelerography. During propofol and sufentanil induction 2 × ED95 was administered as a bolus. This was followed by a potency-adjusted infusion targeted towards maintaining the first twitch at 15 ± 5% of control until chest closure. Bolus and infusion costs were compared taking into account the number of entire vials used. Results are expressed as mean ± SD.
Results and Discussions: Groups were similar with regards to age (65 ± 10 yrs), weight (74 ± 13 kg), renal and hepatic function. For tracheal intubation of patients weighing up to 125 kg, mivacurium was the most cost-effective. For infusions lasting up to 1.72 hrs, mivacurium was the cheapest. The second best place was shared by atracurium (from 1.72 to 2.39 hrs and from 4.12 to 7.17 hrs) and cisatracurium (from 2.39 to 4.12 hrs and 7.17 to 8.24 hrs).
Conclusion(s): The findings of this prospective, randomized, double blind study suggest that mivacurium is the most cost-effective NMBA for both tracheal intubation and continuous infusions lasting up to 1.72 h.
1 DeMonaco HJ et al.
J Clin Anesth 1994; 6: 383-7.