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A first-pass cost analysis of propofol versus barbiturates for children undergoing magnetic resonance imaging
1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06510.
Insights
Intravenous propofol offers faster recovery and discharge for pediatric MRI sedation compared to barbiturates. Despite higher drug costs, propofol leads to significant savings in postanesthesia care unit nursing time.
Area of Science:
- Pediatric Anesthesiology
- Neuroimaging Sedation
- Pharmacology
Background:
- Sedation is crucial for pediatric patients undergoing magnetic resonance imaging (MRI).
- Traditional sedatives like thiopental/pentobarbital have limitations in recovery time.
- Propofol is an alternative anesthetic agent with a different pharmacokinetic profile.
Purpose of the Study:
- To compare the efficacy and recovery profiles of intravenous propofol versus intravenous thiopental/pentobarbital for pediatric MRI sedation.
- To evaluate the cost-effectiveness of propofol compared to barbiturates in this setting.
Main Methods:
- A randomized study of 58 pediatric outpatients (ASA I-II) undergoing brain or spine MRI.
- Group I received propofol; Group II received thiopental/pentobarbital with supplemental doses.
- Recovery and discharge times were assessed by a blinded observer; cost analysis was performed.
Main Results:
- Significantly faster recovery to full consciousness with propofol (19 min) versus barbiturates (35 min).
- Significantly shorter discharge times observed in the propofol group (24 min) compared to the barbiturate group (40 min).
- No significant differences in patient morbidity or MRI scan quality between groups.
Conclusions:
- Propofol provides a more suitable sedation option for pediatric outpatient MRI procedures due to faster recovery.
- Despite higher initial drug costs, propofol can lead to overall cost savings through reduced postanesthesia care unit nursing time.
- Clinical data suggests propofol is advantageous over barbiturates for pediatric MRI sedation.
Abstract:
Intravenous (IV) propofol was compared with IV thiopental/pentobarbital as a sedative for children undergoing magnetic resonance imaging (MRI) of the brain or spine. Fifty-eight outpatients (aged 11 mo to 6 1/2 yr, ASA grade I and II) were enrolled in the study and randomized to two groups. After IV cannulation, Group I received IV propofol (1-2 mg/kg), followed immediately by a propofol infusion (75-100 micrograms.kg-1.min-1). Group II received IV thiopental (1-3 mg/kg) followed by a pentobarbital bolus (2-3 mg/kg). Supplemental thiopental doses (1-2 mg/kg) were administrated to maintain adequate sedation. Discharge time and postanesthesia recovery scores were determined by an independent blinded observer. Time of recovery to full consciousness in Group I was significantly less than in Group II (19 +/- 7 min vs 35 +/- 20; P < 0.005). Time to discharge was also significantly less in Group I (24 +/- 6 min vs 40 +/- 11; P < 0.05). A preliminary cost analysis was applied to the clinical data obtained and to a theoretical model of a pediatric MRI center. Cost analysis of anesthesia services revealed added drug costs ($1600.76 per year for the propofol group) but significant savings of postanesthesia care unit (PACU) nursing time ($5086.67 per year). Outcomes such as patient morbidity and technical quality of the MRI scans did not differ significantly between the two groups. In conclusion, analysis of the clinical data suggests that propofol may be more suitable than barbiturates for children undergoing outpatient procedures despite its higher price.