Under “real world” conditions, desflurane increases drug cost without speeding discharge after short ambulatory anesthesia compared to isoflurane

Purpose To compare the measured “real world” perioperative drug cost and recovery associated with desflurane- and isoflurane-based anesthesia in short (less than one hour) ambulatory surgery. Methods We conducted a prospective, randomized, blinded trial with patients undergoing arthroscopic meniscectomy under general anesthesia. Following iv induction, patients received either isoflurane (group I; n = 25) or desflurane (group D; n = 20) for maintenance. The primary outcome variable was total perioperative drug cost per patient in Canadian dollars. Secondary outcome variables included volatile agent consumption and cost, adjuvant anesthetic and postanesthesia care unit (PACU) drug cost, readiness for PACU discharge, and incidence of adverse events. Results Total perioperative drug cost per patient was $14.58 ± 6.83 (mean ± standard deviation) for group I, and $21.47 ± 5.18 for group D (P < 0.001). Isoflurane consumption per patient was 6.0 ± 3.0 mL compared to 18.6 ± 7.7 mL for desflurane (P < 0.0001); corresponding costs were $0.83 ± 0.42 vs $7.61 ± 3.15 (P < 0.0001). There were no differences in adjuvant anesthetic or PACU drug cost. All but one patient from each group were deemed ready for PACU discharge at 15 min postoperatively (Aldrete score ≥ 9). One patient in group D experienced postoperative nausea. No other adverse events were noted. Conclusions Measured total perioperative drug cost for a short ambulatory procedure (less than one hour) under general anesthesia was higher when desflurane rather than isoflurane was used for maintenance, essentially due to volatile agent cost. Desflurane use did not translate into faster PACU discharge under “real world” conditions.