Debunking Volatile Anesthetic Cost Myths Between Sevoflurane and Desflurane

Abstract

Inhalational agents have been a mainstay in anesthesia practice. Nitrous oxide, the world’s first inhalational agent, was synthesized in 1772 and is still in use today. By the late 1800s diethyl ether, and chloroform, volatile anesthetic agents (VAAs) were introduced and administered by anesthesia professionals to facilitate surgery.  Volatile anesthetic agents, while inhalation agents, were liquids as opposed to a gas at room temperature. Therefore, VAAs were inhalation agents that were volatile (evaporated) emitting gases that produced anesthesia. Halogenated (addition of Cl, Fl, Br) hydrocarbon chain VAAs were created in the 1940s and were safer, more stable, and more potent anesthetic agents. The early VAAs had negative side effects and properties that included flammability, high incidence of nausea and vomiting, and high tissue solubilities causing prolonged wake up times (emergence). In order to meet the growing needs for a rapid acting and dissipating anesthetic agent for surgery, lower solubility volatile anesthetic agents (VAAs) were created: isoflurane (1981), desflurane (1992), and sevoflurane (1995). Nurse anesthetists have better control and timing of their anesthetic technique by using these lower solubility agents. The two newest and relatively more expensive agents, sevoflurane and desflurane, have many benefits including faster induction and emergence. Using sevoflurane or desflurane may or may not increase the cost of anesthesia when compared to older VAAs. Is it beneficial to choose one of these newer agent’s based on cost differences between the two?  Determining the actual cost of specific VAAs is important to many individuals and institutions that attempt to buffer the rising cost of healthcare by cost effective use of drugs and therapies.