Managing inhaled anesthesia: challenges from a health-system pharmacist's perspective

To discuss the challenges that health-system pharmacists face in managing the use and costs of inhaled anesthesia in the operating room (OR), the characteristics of inhaled anesthesia agents, systems for delivering inhaled anesthesia, and the role of inhaled anesthetics in fast-track recovery after surgery.

Inhaled anesthetic agents are the most common drugs used in general anesthesia and are a substantial part of the anesthetic drug budget in health systems. Challenges for health-system pharmacists in managing costs associated with these agents include the lack of a dedicated OR pharmacy, limited access to the OR, unfamiliarity with some of the medications used in the OR, and difficulty quantifying inhaled anesthetic drug use. The three inhaled anesthesia agents currently used in the United States have proven to be safe and effective. These agents have differences in solubility in blood and tissues, which affect onset, absorption, and excretion. Isoflurane has the highest solubility in blood and tissues, which may result in slower recovery. Lower solubility allows for a faster recovery. The two newest agents on the market, sevoflurane and desflurane, both have low solubility, with desflurane having lower solubility than sevoflurane. Sevoflurane has the advantage of low pungency and is not associated with respiratory irritation. As a cost-savings initiative, the inhalation agents may be used with low flow rates, which minimizes the amount of inhaled anesthetic used. In addition, using the less soluble inhaled anesthetic agents as part of a fast-track approach will accelerate recovery by reducing time to emergence and recovery. This approach can potentially reduce costs to the institution.

Understanding the differences in characteristics and delivery of the inhaled anesthesia agents will enable health-system pharmacists to collaborate with anesthesia care providers to better manage the use and costs of these agents.