Bisulfite-containing propofol: Is it a cost-effective alternative to Diprivan (TM) for induction of anesthesia?

Propofol (Diprivan(TM); AstraZeneca, Wilmington, DE) is a commonly used dru g for the induction of general anesthesia in the ambulatory setting. With t he availability of a new bisulfite-containing generic formulation of propof ol, questions have arisen regarding its cost effectiveness and safety compa red with Diprivan(TM). Two hundred healthy outpatients were randomly assign ed, according to a double-blinded protocol, to receive either Diprivan(TM) or bisulfite-containing propofol 1.5 mg/kg IV as part of a standardized ind uction sequence. Maintenance of anesthesia consisted of either desflurane ( 4%-8% end-tidal) or sevoflurane (1%-2% end-tidal) in combination with a rem ifentanil infusion (0.125 mu g . kg(-1) . min(-1) IV). Patient assessments included pain on injection, induction time, hemodynamic and bispectral elec troencephalographic changes during induction, emergence time, and incidence of postoperative nausea and vomiting. The two propofol groups were compara ble demographically, and the induction times and bispectral index values du ring the induction were also similar. However, the bisulfite-containing for mulation was associated with less severe pain on injection (5% vs 11%), wit h fewer patients recalling pain on injection after surgery (38% vs 51%, P < 0.05). None of the patients manifested allergic-type reactions after the i nduction of anesthesia. The acquisition cost (average wholesale price in US dollars) of a 20-mL ampoule of Diprivan(TM) was $15 compared with $13 for the bisulfite-containing propofol formulation. Therefore, we concluded that the bisulfite-containing formulation of propofol is a cost-effective alter native to Diprivan(TM) for the induction of outpatient anesthesia.