Sevoflurane use in Veterans Affairs medical centers: utility, safety, and cost-effectiveness

It has long been realized that the Veterans Affairs (VA) patient has a high incidence of multiorgan system diseases, especially diseases of the pulmonary and cardiovascular systems. The typical Birmingham VA Medical Center patient presenting for surgery is male, with a national mean age of 60 years. More than one half of these patients have a significant history of current or prior tobacco abuse, and many have cardiovascular impairments. When sevoflurane became available, a careful review of the characteristics of the drug, as well as cost comparisons of inhaled agents, was done by our department of anesthesia. Sevoflurane appears to be an ideal inhaled anesthetic for the veteran patient population. If used appropriately, sevoflurane can be administered safely at a cost comparable to desflurane.