So i have read a little about the different gasses used in the Anes. profession. It seems the most common are nitrous oxide, sevoflurane,desflurane,isoflurane and halothane.
I understand some of the ins and outs such as sevoflurane and halothane are easy to inhale while desflurane is very irritating to inhale and has a shorter duration of action. If a very short-acting anesthetic is needed, the anesthesiologist can switch to desflurane after you fall asleep. Nitrous oxide is easy to inhale, but when used alone is not potent enough to be a complete general anesthetic. However, it can be used alone for sedation, or combined with one of the other inhaled anesthetics or injected liquid anesthetics for general anesthesia.
They all seem to have some interesting properties. For example:
- halothane may cause the heart rate to slow down and the blood pressure to decrease while desflurane may cause the heart rate to speed up and the blood pressure to increase.
It seems an important property of anesthetics is reversibility. If i understand it correctly, once the anesthetic gas is turned off, the blood stream brings the gas back to the lungs where it is eliminated. The more soluble the gas is in blood, the longer it takes to eliminate. Nitrous oxide and desflurane are the shortest-acting anesthetic gases because they are the least soluble in blood.
So I guess where Im a little confused is why it wouldnt be equally as good to use diprivan or vecc and a versed drip etc etc. All those combinations that are commonly used. What advantages does utilizing a gas machine and the various gasses have over those other drugs?
thats interesting. Not something thats considered at all in acute medicine but i can see it happening in the ICU all the time and any inpatient setting. I had not considered that in regards to the OR. Really, whats a few hundread bucks on gas when the CABG is 20K? Seems irrelevant.
I made a post about this earlier, but sometimes things just don't seem as important when you look at the big picture, like Mike alluded to.
Doing bilateral shattered femurs the other day and some orthopod couldn't get what he wanted out of a standard ortho tray. So out come the silver trays in search of what he wanted. This is in addition to what was already being used for the femurs in the first place. Two additional tables were brought in just to accommodate the extra trays. I personally have never seen so many trays being utlilized (actually underutilized) in one case ever.
Head MD of our anesthesia group walks in and says in rather amusing language that the total money for all these trays is more than the note on his house is.
Cost of botle of sevo: ~90 something bucks.
Cost of bottle of iso: $24
Using Tegaderms instead of paper tape: $1 per Tegaderm
Hospital cost of 1L of fluid: $0.98
500 ml Hespan: $14.03 - this is what you will see most people talk about cost and from a standard crystalloid comparison, Hespan is through the roof.
that totally debunks the idea that it is important to consider cost of anestesia on an operation that is costly. It not only dosent make sense, but it is irrelevant.
BTW I bought a couple more things to play with
The Airway cam DVD's for the classes i teach (i teach difficult intubation and multiple techniques) & an online update thing for millers so it dosent get dated!
I made a post about this earlier, but sometimes things just don't seem as important when you look at the big picture, like Mike alluded to.
Doing bilateral shattered femurs the other day and some orthopod couldn't get what he wanted out of a standard ortho tray. So out come the silver trays in search of what he wanted. This is in addition to what was already being used for the femurs in the first place. Two additional tables were brought in just to accommodate the extra trays. I personally have never seen so many trays being utlilized (actually underutilized) in one case ever.
Head MD of our anesthesia group walks in and says in rather amusing language that the total money for all these trays is more than the note on his house is.
Cost of botle of sevo: ~90 something bucks.
Cost of bottle of iso: $24
Using Tegaderms instead of paper tape: $1 per Tegaderm
Hospital cost of 1L of fluid: $0.98
500 ml Hespan: $14.03 - this is what you will see most people talk about cost and from a standard crystalloid comparison, Hespan is through the roof.
Actually all halogenated agents can bronchodilate. Sevo is used for inhaled induction b/c it lacks the pungent odor that Iso and Des has (smells like ether) It is the odor of these that cause coughing and upper airway irritation which can lead to bronchospasm. However if the tub is in and you are running Des of Iso and the pt is asleep all the halogenated agents cause bronchodilation.
boy...hope i can get myself straight before i take boards in 30 days or so...
money is always the bottom line... i always use what is best for my patients...however... when vec can be used instead of roc... that is money in my employer pockets...and eventually in mine.
Anesthesia is expensive. I forget what the machine costs but it is in the tens of thousands, and they require techs and servicing. The staff are well paid. The newer drugs like brand name Diprivan, fentanyl analogues and rocuronium cost a fortune. I agree that a dollar per liter of fluid or Tegaderm seems like a negligible amount in health care, but if you add in the money you can save on supplies and drugs you're looking at amounts big enough to care about. I know the surgery is huge in comparison, but still. Money is money.
My understanding is that sevo is MORE expensive than des because despite the lower MAC, you have to run your O2/air at 2 liters the whole case, which wastes gas. I'm interested if anyone knows the relative costs when you take these factors into account.
My understanding is that sevo is MORE expensive than des because despite the lower MAC, you have to run your O2/air at 2 liters the whole case, which wastes gas. I'm interested if anyone knows the relative costs when you take these factors into account.
The fact that most numbers generated by the industry are complicated by hospitals having contracts with companies and therefore reduced rates for these items.
For the record, we don't even have des at my main level one. Iso rules here. We know how to use it and technique can maintain turn around times despite the pharmacological differences. Fentanyl is a mainstay here also.
The Airway cam DVD's for the classes i teach (i teach difficult intubation and multiple techniques) & an online update thing for millers so it dosent get dated!
Airway cam is cool, but wait until you see a Glidescope in practice.
Yahoo! it or search with Google.
This is an AMAZING device, esp for teaching juniors to intubate. Instead of going in on the first time and not really knowing to to look for, how to manipulate the environment - what this product should be used for is teaching those unfamiliar with the airway (probably not you, but others) exactly how to intubate and landmarkings. That'd be smoother than my first couple experiences with 3 people standing over me, all yelling, "Whaddya see?"
You can always tell who played video games when someone is using the Glidescope for intubations.
sevo can be run on low flows for 2 full MAC hours w/o complication and the only complication they are seeing after that isn't compound A it is heat/fires in the absorbers.... so that can cut some expense.
MmacFN
556 Posts
thats interesting. Not something thats considered at all in acute medicine but i can see it happening in the ICU all the time and any inpatient setting. I had not considered that in regards to the OR. Really, whats a few hundread bucks on gas when the CABG is 20K? Seems irrelevant.