Related Experiment Videos
[Clinical pathway "laparoscopic prostatectomy". Analysis of anesthesiological procedures in a randomized study]
1Klinik für Anästhesiologie und operative Intensivmedizin, Charité Universitätsmedizin, Campus Mitte, Schumannstrasse 20-21, 10117 Berlin. jan.braun@charite.de
Der Anaesthesist
|August 3, 2005
Summary
Total intravenous anesthesia (TIVA) and balanced minimal flow anesthesia are equally effective for laparoscopic prostatectomy. Desflurane anesthesia led to faster recovery but increased pain, requiring more analgesics, while both methods proved cost-effective.
Area of Science:
- Anesthesiology
- Surgical Pathway Optimization
- Health Economics
Context:
- Investigating the anesthesiological module within clinical pathways.
- Focusing on laparoscopic prostatectomy as a time-consuming minimally invasive surgery example.
- Comparing total intravenous anesthesia (TIVA) with propofol/remifentanil against balanced minimal flow anesthesia with desflurane/remifentanil in 40 patients.
Purpose:
- To evaluate and compare the quality indicators (vigilance, pain, PONV, mobilization) and costs of TIVA versus balanced minimal flow anesthesia during laparoscopic prostatectomy.
- To determine the cost-effectiveness and patient outcomes associated with different anesthetic techniques in a specific surgical pathway.
Summary:
- Both TIVA and desflurane anesthesia were well-tolerated with no pathway deviations. Desflurane group showed faster recovery (p=0.037) but experienced more pain, necessitating higher analgesic use (p=0.017).
- Anesthesia costs per minute were comparable (Propofol: 2.79 EUR, Desflurane: 2.68 EUR), with total costs within DRG ranges, though medication costs exceeded DRG proceeds.
- Both anesthetic approaches support cost-effective management for lengthy procedures, but require tailored analgesic and antiemetic strategies.
Impact:
- Highlights the need for adjusted prophylactic analgesic and antiemetic administration based on anesthetic choice for long procedures.
- Suggests that optimizing anesthesiological procedures can enhance the quality of therapeutic pathways.
- Provides insights into cost-effectiveness and patient outcomes for different anesthesia types in minimally invasive surgery.