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ECONOMICS AND HEALTH SYSTEMS RESEARCH

The Costs of Intense Neuromuscular Block for Anesthesia During Endolaryngeal Procedures Due to Waiting Time

Arto I. E. Puura, MD^*, Michael G. F. Rorarius, MD, PhD, Pia Manninen, MD, Sanna Hopput, MD, and Gerhard A. Baer, MD, PhD

*Department of Anaesthesia, Municipal Hospital of Valkeakoski; Department of Anaesthesia, Tampere University Hospital and Medical School; and Medical School, University of Tampere, Tampere, Finland

Address correspondence and reprint requests to Arto Puura, MD, Katajatie 19 B, FIN-36200 Kangasala, Finland. Address e-mail to puura{at}sci.fi

The goal of this double-blinded, prospective study was to compare the costs incurred by waiting time of intense neuromuscular block while posttetanic count (PTC) was maintained at 0–2 during jet ventilation. Fifty patients were randomized into five groups to receive atracurium (ATR), mivacurium (MIV), rocuronium (ROC), vecuronium (VEC), and succinylcholine (SUCC). PTC 2 was maintained until completion of laryngomicroscopy by administering additional doses of relaxants or by adjusting the speed of the infusion of SUCC. We compared waiting time, i.e., onset time and recovery time, and costs of intense neuromuscular block. The expenses due to waiting time were calculated based on the average costs in the otorhinolaryngological operating room in Tampere University Hospital: FIM 40 (approximately $8) per minute in 1997. MIV and SUCC differ favorably from ATR, ROC, and VEC when waiting time and costs are concerned. The recovery times with MIV and SUCC were considerably shorter than those with ATR, ROC, and VEC (P < 0.001 in all pairwise comparisons). Using the muscle relaxant with the longest waiting time instead of that with the shortest waiting time (difference 21.8 min) cost more than FIM 800 (approximately $160) extra per patient.

Implications: In this randomized, double-blinded, prospective study, we evaluated the costs of intense neuromuscular block due to waiting time. Succinylcholine and mivacurium are the most economical muscle relaxants to use when intense neuromuscular block is mandatory. Using intermediate-acting muscle relaxants results in unduly prolonged recovery time and extra costs.