Inhalation versus total intravenous anesthesia for lumbar disc herniation - Comparison of hemodynamic effects, recovery characteristics, and cost

The clinical effects, recovery characteristics, and costs of total intraven ous anesthesia (TIVA). sevoflurane, and isoflurane anesthesia have been mea sured in various out-patient operations, but have not been evaluated in pat ients undergoing laminectomy or discectomy. In the current study, the autho rs assessed the hemodynamic characteristics, recovery, and cost analyzes af ter laminectomy and discectomy operations, comparing TIVA, sevoflurane,, an d isoflurane anesthesia. Sixty American Society of Anesthesiologists I and II patients were randomly divided into three groups, each consisting of 20 patients. Group I received propofol-alfentanil, Group 2 received sevofluran e-N2O, and Group 3 received isoflurane-N2O. At the end of surgery, the anes thetics were discontinued, and recovery from anesthesia was assessed by mea suring the time until spontaneous eye opening and the time until response t o verbal commands. The drug and delivery costs were calculated in United St ates dollars. No significant differences were found in the demographic data . Heart rate and mean arterial pressure decreased significantly after induc tion of anesthesia in the TIVA group, compared to the two other groups (P < .05 for both comparisons). The fastest recovery was seen in the TIVA group . Incidences of postoperative nausea, vomiting, and pain were significantly reduced after TIVA (P < .05 for both comparisons). Thus, TIVA patients req uired fewer additional drugs and showed the lowest additional costs in the post-anesthesia care unit. However, the total cost was significantly higher in the TIVA group than in the sevoflurane and isoflurane groups ($52.73, $ 29.99, and $24.14, respectively) (P < .05). Total intravenous anesthesia wa s associated with the highest intraoperative cost but provided the most rap id recovery from anesthesia, and the least frequent postoperative side effe cts.