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12 Literature review intermediate and late recovery. Ong and co-workers 106 also compared propofol total intravenous anaesthesia (TIVA) with sevoflurane total inhalational anaesthesia. There was no difference with respect to early and intermediate recovery, but N 2O was given to one group (sevoflurane) only. Fish and co-workers 72 also found no difference with respect to early and intermediate recovery. In the final study, which examined propofol and sevoflurane induction of anaesthesia, no measurements of recovery were made. 125 Thiopentone and sevoflurane One study 107 compared these two agents for induction. Sevoflurane was superior to thiopentone in terms of the number of patients able to walk unaided after 30 minutes. There was a higher incidence of arrhythmias in the thiopentone group. Thiopentone and desflurane One study 73 compared these two agents for induction. Four separate patient groups were included, and in two groups the only difference was the induction agent, thiopentone 5 mg/kg or desflurane. Thiopentone was inferior to desflurane with respect to intermediate recovery and choice reaction time, but not with respect to critical flicker fusion threshold. Propofol and desflurane Five studies were found. 51,90,116,133,137 Apfelbaum and co-workers 51 studied 20 volunteers, each of whom received a different anaesthetic technique on four separate occasions. Two of these techniques differed only with respect to induction of anaesthesia (propofol 2.5 mg/kg or desflurane 3%), desflurane being used for maintenance. With respect to early and intermediate recovery, those who received desflurane for induction recovered more rapidly. Late recovery measurements showed no differences between the groups. The psychomotor tests at 1 hour showed a number of differences, but the first group was better at some tests and the second at others, and there was no difference in the remainder. Psychomotor tests beyond 1 hour showed no difference between the groups. A similar set of four anaesthetic techniques was examined in the remaining studies. There was no difference between the propofol induction and desflurane induction groups with respect to early, intermediate, late or psychomotor recoveries. Maintenance of anaesthesia Isoflurane and sevoflurane Four studies compared these two agents for maintenance. 68,104,108,124 In two studies 68,108 propofol was used for induction and fentanyl for analgesia. In both studies, early, intermediate and psychomotor studies showed sevoflurane to be superior to isoflurane, although there was no difference with respect to late recovery. In a third study, 104 involving patients who received thiopentone for induction, there was no difference between isoflurane and sevoflurane. The fourth study 124 used the same agent (sevoflurane or isoflurane) for induction of anaesthesia by single vital capacity breath, and demonstrated no difference between sevoflurane and isoflurane. Isoflurane and halothane These two agents were compared in two studies. 58,109 All patients received propofol for induction of anaesthesia. No difference was found in the results of psychomotor tests between the patients who received isoflurane and those who received halothane. Isoflurane and enflurane Three studies 62,82,109 compared this pair of agents for maintenance of anaesthesia following propofol for induction. Pollard and co-workers 109 found that enflurane was better than isoflurane in terms of psychomotor recovery. Chung and co-workers 62 found no difference with respect to early, intermediate or late recovery. Hovorka and co-workers 82 found no difference in terms of PONV. Enflurane and halothane Three studies compared these agents for maintenance of anaesthesia. 55,58,109 Pollard and co-workers 109 used propofol for induction. Those patients who received enflurane recovered more rapidly than those who received halothane, although only psychomotor tests were used. Biswas and Hatch 55 used thiopentone for induction. Enflurane was better than halothane with respect to early and intermediate recovery, but no difference was found with respect to psychomotor recovery. Carter and co-workers 58 standardised induction and used propofol. No difference in recovery was found between enflurane and halothane. Sevoflurane and desflurane These two maintenance agents were compared in three studies. 98,100,130 All studies used propofol for induction of anaesthesia and also used an opioid (fentanyl in the first two, and alfentanil in the third). All patients in the first two studies received N 2O, whereas none did so in the third study. Two studies 98,100 showed early recovery from desflurane to be faster than sevoflurane, but in the third study there was no difference. There was no difference
with respect to late recovery in any study. Psychomotor recovery after desflurane was faster than after sevoflurane in the absence of N 2O, but in those patients who received N 2O there was no difference. Isoflurane and desflurane These agents were compared in three studies, 79,95,223 all of which used propofol for induction. Gupta and co-workers 79 and Rieker 226 added either fentanyl or alfentanil. A fourth study 73 used thiopentone for induction, with no opioid. In all cases desflurane was better than isoflurane with respect to early and intermediate recovery, but there was no difference between the agents with respect to later recovery. In the patients who had received propofol for induction, psychomotor recovery was better after desflurane than after isoflurane, although there was no difference between the two agents when thiopentone was used for induction. Propofol and sevoflurane Seven studies compared sevoflurane with propofol for maintenance anaesthesia. 57,72,74,106,113,125,126 Sevoflurane appears to be superior to propofol in its recovery characteristics (Table 2). Propofol and desflurane Ten studies compared these two agents for maintenance anaesthesia. 51,53,57,69,90,95,113,116,130,133 In all cases propofol was used for induction of anaesthesia. In most cases there were no differences. Desflurane was superior to propofol for early and intermediate recovery in three of the ten studies, and with respect to psychomotor recovery in one study. Propofol was better than desflurane with respect to late recovery in two studies. It would seem that any difference between these two techniques is of a minor and inconsequential nature. TABLE 2 Comparison of recovery after sevoflurane or propofol maintenance anaesthesia © Queen’s Printer and Controller of HMSO 2002. All rights reserved. Health Technology Assessment 2002; Vol. 6: No. 30 Propofol and enflurane These agents were compared in three studies. 62,66,109 Patients received propofol for induction of anaesthesia in two of the studies and thiamylal for induction in the third study. In two studies no differences were found between those patients who received enflurane and those who received propofol with respect to early, intermediate, late or psychomotor recovery. Both immediate and intermediate recovery were more rapid after propofol anaesthesia than after thiamylal– enflurane anaesthesia. Propofol and halothane These agents were compared in two studies. 109,224 All patients received propofol for induction of anaesthesia. In the first study, psychomotor recovery only was measured and this was found to be faster in those patients who received propofol than in those who received halothane. The second study found no difference with respect to intermediate, late or psychomotor recovery. Propofol and isoflurane Nineteen studies compared these two agents for maintenance anaesthesia. 53,62,63,75,78,88,91,93,95,97,86,89,101, 103,105,109,132,135,136 Of those, 14 studies used propofol for induction followed by either propofol or isoflurane for maintenance. The remainder used thiopentone (three studies), methohexitone (one study) or etomidate (one study) for induction. The results are summarised in Table 3. The studies in which propofol was used for induction support there being no differences between the propofol group or the isoflurane group with respect to early, intermediate, late or psychomotor recovery (see Table 3). In the other five studies, all patients in the propofol induction and maintenance group showed superior recovery characteristics for early, intermediate and later Study Early Intermediate Late Psychomotor recovery recovery recovery recovery Carroll et al., 1997 57 Fish et al., 1999 72 Fredman et al., 1995 74 Ong et al., 2000 106 Raeder et al., 1998 113 Smith and Thwaites, 1999 125 Soing et al., 1998 126 S S S S ND ND NE NE ND ND NE NE S ND P NE S S ND S S S ND NE ND ND ND NE ND, no difference; NE, not examined; P, propofol better than sevoflurane; S, sevoflurane better than propofol 13
Page 1 and 2: Which anaesthetic agents are costef
Page 3: Which anaesthetic agents are costef
Page 6 and 7: NHS R&D HTA Programme The NHS R&D H
Page 8 and 9: Contents Appendix 6 Adult patient-b
Page 11 and 12: Background The aim of the project w
Page 13: • The incidence of PONV was low d
Page 16 and 17: 2 Introduction dizziness or disorie
Page 18 and 19: 4 Introduction a reduced incidence
Page 20 and 21: 6 Introduction willingness to pay f
Page 22 and 23: 8 Literature review included in the
Page 24 and 25: 10 Literature review TABLE 1 Compar
Page 32 and 33: 18 Literature review Patient-based
Page 34 and 35: 20 Literature review TABLE 5 contd
Page 36 and 37: 22 Literature review No studies fol
Page 38 and 39: 24 Literature review (30%) and meth
Page 40 and 41: 26 Literature review • There are
Page 42 and 43: 28 National survey of anaesthetic p
Page 50 and 51: 36 Economic evaluation methods (inc
Page 52 and 53: 38 Economic evaluation methods The
Page 54 and 55: 40 Economic evaluation methods Tabl
Page 56 and 57: 42 Economic evaluation methods simi
Page 58 and 59: 44 Economic evaluation methods Prob
Page 61 and 62: Recruitment to the CESA RCT The stu
Page 63 and 64: Clinical outcome data PONV by anaes
Page 65 and 66: The findings from the logistic regr
Page 67 and 68: TABLE 29 The length of stay and pri
Page 69 and 70: 140 120 100 80 60 40 20 0 No. of pa
Page 71 and 72: 250 200 150 100 50 0 No. of patient
Page 73 and 74: TABLE 37 Deterministic sensitivity
Page 75 and 76: 20 15 10 5 0 -5 Difference in varia
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Patient admitted for day surgery an
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500 400 300 200 100 0 -100 -200 -30
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Recruitment to the CESA RCT The stu
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TABLE 49 The occurrence of any PONV
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60 50 40 30 20 10 0 No. of patients
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a scale effect for scenario A, but
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The mean CVs for avoidance of PONV
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1.80 The new variable cost and tota
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100 90 80 70 60 50 40 30 20 10 0 Su
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The structure and content of this d
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nurses to have an in-depth knowledg
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agent used (see appendix 18). It wa
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Furthermore, anaesthetists operate
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The CESA project was designed to as
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practice, such as the use of midazo
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1. Royal College of Surgeons of Eng
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60. Cheng KI, Chu KS, Fang YR, Su K
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112. Raeder J, Gupta A, Pedersen FM
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162. Viitanen H, Baer G, Annila P.
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220. Rosenberg KM, Bridge P, Brown
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The range of databases interrogated
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24. preferen$.mp. [mp=title, abstra
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110 Appendix 2 TABLE 65 contd Summa
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112 Appendix 3 Quality assessment o
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TABLE 69 Summary of paediatric pati
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TABLE 69 contd Summary of paediatri
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TABLE 70 Characteristics of cost or
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TABLE 71 Quality of cost or economi
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TABLE 71 contd Quality of cost or e
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Abbott J, Abbott P. Psychological a
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Hall JE, Stewart JIM, Harmer M. Sin
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Struys M, Versichelen L, Thas O, He
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182 Appendix 11
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184 Appendix 11
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186 Appendix 11
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188 Appendix 11
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The aim of this study was to develo
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anaesthetics in day surgery, using
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© Queen’s Printer and Controller
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Background The empirical study quan
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Satisfaction with care Nearly all (
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TABLE 76 Reason given for preferenc
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TABLE 79 Comparisons with previous
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TABLE 80 Reason given for preferenc
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TABLE 81 Reason given for willingne
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Background Variable costs account f
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TABLE 85 Unit costs for the purchas
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Background The empirical study requ
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Ethical approval This was covered b
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20 15 10 5 0 -5 -10 -15 True weight
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15 10 5 0 -5 -10 True weight - Dion
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224 Appendix 19 • patients aged o
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All staff unit costs were for the y
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Background Fixed costs account for
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232 Appendix 22 March, Tuesday 15 A
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234 Appendix 23 TABLE 96 Reasons fo
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Patients were coded using the OPCS
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Q03.4 punch biopsy of cervix Q03.5
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This section displays the associati
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given in Table 103 confirm the age
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TABLE 107 Occurrence of PONV by dur
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248 Appendix 27 TABLE 113 Frequency
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This section displays the associati
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The adverse events observed in the
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262 Health Technology Assessment Pr
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264 Health Technology Assessment Pr
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