Low‐flow isoflurane‐nitrous oxide anaesthesia offers substantial economic advantages over high‐and medium‐flow isoflurane‐nitrous oxide anaesthesia

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Abstract
Isoflurane consumption was studied for three different fresh gas flows in patients scheduled for major elective abdominal, urological or gynaecological surgery under general anaesthesia with an expected duration of 2 h or more. Thirty patients were randomly assigned to either high‐flow anaesthesia using a partial rebreathing system without carbon dioxide absorption (Mapleson D) or medium‐ or low‐flow anaesthesia using a circle system with carbon dioxide absorption. Patients were anaesthetised with isoflurane in 40% oxygen and 60% nitrous oxide. The amount of isoflurane consumed was measured with a precision scale. The total consumption of liquid isoflurane (mean ± s.d.) during the first 2 h was 40.8± 12.2 ml in the high‐flow group, 18.5 ± 5.4 ml in the medium‐flow group and 7.9 ± 2.2 ml in the low‐flow group. The corresponding cost of isoflurane for the three groups was 214 Danish kroner (DKK) (±19.5), 97 DKK (±8.8) and 42 DKK (±3.8), respectively. The calculated total cost of anaesthetics was 286 DKK(±26), 155 DKK (±14.1) and 91 DKK (±8.3), respectively. In conclusion, low‐flow isoflurane‐nitrous oxide anaesthesia offers substantial economic advantages over high‐ and medium‐flow isoflurane‐nitrous oxide anaesthesia.

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