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Role of rapid short-acting anesthetics, analgesics and muscle relaxants in ambulatory anesthesia.

The availability of newer anesthetic, analgesic and muscle relaxant drugs which provide for a faster onset, easier titration and a more rapid recovery have facilitated the practice of ambulatory anesthesia (1). Not surprisingly, these newer anesthetic drugs are more costly than the agents they are designed to replace. However, in assessing the financial consequences of using these newer drugs and anesthetic techniques, it is important to examine both the direct and the indirect costs associated with their use in the ambulatory setting (2). Claims regarding cost-effectiveness of anesthetic drugs should be subjected to close scrutiny, with studies specifically designed to evaluate the impact of a given drug on personnel costs, ability of the patients and their caretakers to resume their normal activities, and allow the surgeon to complete an additional surgical procedure in the same operating room session. It may be necessary to alter work patterns (eg., discharge policies) to obtain the full benefits of the new rapid, short-acting drugs in the ambulatory setting (e.g., bypassing the labor-intensive Phase I postanesthesia care unit). It has been shown that greater cost savings in the operating room can be achieved by increasing efficiency in resource use than by limiting the availability of new anaesthetic drugs (3). A mere 30-minute delay in the arrival of a surgeon can negate any cost savings related to the anesthesiologist's choice of drugs.