





























Debunking Volatile anesthetic cost Myths 
between seVoflurane anD Desflurane
Introducing the Volatile Anesthetic Cost Calculator (CRNA 
iVAC©) iApp

John Varkey CRNA, DNP and Mark Welliver CRNA, DNP

IntroductIon

Inhalational agents have been a mainstay in anesthesia practice. 
Nitrous oxide, the world’s first inhalational agent, was synthe-
sized in 1772 and is still in use today.1 By the late 1800s diethyl 
ether, and chloroform, volatile anesthetic agents (VAAs) were 
introduced and administered by anesthesia professionals to facili-
tate surgery.1 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) emit-
ting 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.1 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 dissi-
pating anesthetic agent for surgery, lower solubility volatile anes-
thetic agents (VAAs) were created: isoflurane (1981), desflurane 
(1992), and sevoflurane (1995).1 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.2 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. 

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17

bAcKground

Cost containment and cost effective use of resources has 
become a priority within healthcare. This has created a chal-
lenge for anesthesia providers wanting to deliver high quality 
healthcare that is safe yet economical. In anesthesia, VAAs may 
account for up to 20% of total anesthesia costs.3 Sevoflurane 
and desflurane are the two newest and more expensive VAAs 
compared to isoflurane. Each VAA has its own characteristic 
properties offering distinct advantages. Sevoflurane is a potent 
non-irritating sweet smelling VAA that may be ideal for asth-
matic patients and patients with reactive airways. Sevoflurane is 
a versatile VAA that may be used for mask induction and main-
tenance of anesthesia. Desflurane has the lowest blood gas and 
tissue solubility of all VAAs, making it a preferential agent for 
rapid emergence and earlier cognitive function. Populations that 
may benefit include the bariatric population and cases requiring 
neurological assessment immediately post op. 

Apart from these distinct characteristics the cost for each VAA 
varies among institutions, purchasing contracts, and geographic 
locations. A difficult challenge for institutions is calculating and 
budgeting VAA cost. Cost assessment for intravenous drugs is 
much simpler than VAAs since individual and single dose pack-
aging allows a direct correlation between the amount of drug 
acquired and that delivered per patient. Calculating VAA drug 
cost, especially per patient, is made obscure by the delivery 
method. VAAs are purchased in liquid form and administered 
through a vaporizer, making it difficult to directly measure 
how much VAA is used per case without the aid of additional 
measurement technologies. Varying delivery concentrations and 
delivery techniques may increase or decrease total consumption 
of VAAs and significantly change cost. 

revIew of LIterAture

To perform a cost analysis of sevoflurane versus desflurane, a 
thorough search of the literature was conducted which yielded 



ten articles that specifically calculated the cost of administering 
each VAA. These articles directly compared the cost of admin-
istering sevoflurane and desflurane. Two of the articles were 
from randomized control trials (RCTs). Seven articles favored 
sevoflurane (Table 1) as more cost effective when comparing 
similar flow rates, two articles favored desflurane (Table 2), and 
one article found no significant cost difference between inhala-
tion groups (Table 3). Seven methods were used to determine 
cost of VAA: A precision weighing system, a computer data log, 
Minimum alveolar concentration (MAC), a four compartment 
model, a volume percent formula, Dion’s formula, and Loke’s 
formula. 

precision Weighing System
Boldt et al 4 performed a randomized control trial (RCT) in 

1998 comparing standard and new anesthetic techniques with 
cost. Eighty patients undergoing laparoscopic cholecystectomy 
or a subtotal thyroidectomy were randomly divided into four 
groups. Group 1 received propofol and sufentanil, Group 2 
received desflurane and sufentanil, Group 3 received sevoflurane 
and sufentanil, and Group 4 received isoflurane and sufentanil 
for anesthesia. A fresh gas flow (FGF) (aka carrier gases) of 
1.5-2 L/min of oxygen and 60% nitrous oxide were used during 
maintenance. The average end tidal concentration of sevoflu-
rane ranged from 1.1% to 2.5% and end tidal concentration 
of desflurane ranged from 3.5% to 7.2%. The authors were 
skeptical about the use of formulas and resorted to weighing 
vapors using a precision weighing machine. Volatile anes-
thetic consumption was measured by weighing vaporizers after 
each case using a precision weighing machine. Each agent was 
measured to the nearest 0.1 g and subsequently converted to mL 
(sevoflurane1.52g/mL, desflurane 1.465g/mL). The authors found 
no significant difference between the cost of using sevoflurane 
or desflurane. The authors opposed the use of a static formula 
to determine VAA cost because FGF rates are often adjusted 
throughout a case. According to the authors, the use of precision 
weighing machines allow for precise measurement of consumed 

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liquid quantity. The reduction of FGF, regardless of VAA deliv-
ered, results in considerable VAA cost savings. Theoretically the 
authors proposed desflurane would be more economical than 
sevoflurane at low FGF rates because equilibration (alveolar 
concentration to inspired concentration ratio, FA/FI) occurs 
more rapidly with desflurane. Their finding was no significant 
difference in the cost of administering isoflurane, desflurane, or 
sevoflurane.4

computer data log
Cobos et al 5 at the University of Nebraska Medical Center in 

2007 used a computer to log FGF and inhaled concentrations of 
anesthetics every minute during 47 cases. The authors stated that 
sevoflurane FGF, MAC equivalents, and cost per minute were 
higher than desflurane at their institution. Average FGF for sevo-
flurane was 3.4 L/min and desflurane was 2.1 L/min, and cost 
per minute of sevoflurane was $0.79 and desflurane was $0.56. 
The authors did not mention how they determined cost of each 
VAA. The MAC equivalents listed for sevoflurane is lower than 
desflurane at 0.90 and 1.12 respectively. A MAC equivalent is the 
blood concentration of a VAA as opposed to MAC which refers 
to alveolar gas concentration of a VAA. The authors proposed 
that reducing FGF by half may theoretically decrease the cost 
of all VAAs by half. 5 Although MAC equivalents are useful 
and possibly a better representation of true anesthetic need for 
the patient actual VAA consumption (total amount taken from 
vaporizer) is what directly affects cost.

minimum Alveolar concentration
A simple, but flawed, method to estimate cost is to compare 

acquisition costs of each VAA and assume it will cost three times 
as much to deliver desflurane compared to sevoflurane based 
solely on MAC values. It requires only 2% sevoflurane to induce 
an equivalent MAC produced by 6% desflurane. Using this ratio-
nale some may assume that it will take three times the amount 
of desflurane to produce the anesthesia of sevoflurane. This 
assumption has previously been utilized and described in a 2009 



pharmacy journal.6 It was claimed that, although sevoflurane 
is more expensive per unit than desflurane, it would take three 
bottles of desflurane to produce the anesthesia of one bottle of 
sevoflurane.6 This assumption is supported in part by an edito-
rial in 2010 by Dr. Eger who stated that, although the unit cost 
of sevoflurane was more expensive than desflurane, it would 
take roughly three times the amount of desflurane to create a 
comparable anesthetic depth at a given FGF rate.7 This is due to 
their differences in potency, since approximately 2% of sevoflu-
rane and 6% of desflurane is needed to create one MAC. MAC 
is defined as the minimum alveolar concentration of an inhaled 
anesthetic agent that produces immobility in 50% of the popula-
tion exposed to a surgical incision.8,9 The erroneous assumption 
of direct MAC to unit cost calculation ignores other variables 
involved in true cost calculation including the physics of vapor-
ization, anesthetic delivery techniques, and FGF rates. Actual 
consumption of a VAA determines cost not an assumed potency-
to-potency comparison. Despite stated institutional savings of 
$100,000 over one year no verifiable methods for calculating 
cost or VAA consumption were disclosed and no cost analysis 
was made. 6 Additionally, these “savings” were achieved by 
removing desflurane from the operating suites and limiting anes-
thesia provider choice of agent to be used. 6 

four compartment model
Lockwood and White 10 in 2001 incorporated the Weiskopf 

and Eger four compartment model to create a computer model 
to compare direct cost of isoflurane, desflurane, and sevoflurane 
in open and closed systems. The four-compartment computer 
model takes into consideration the solubility, absorption, and 
elimination of an anesthetic agent in the body. The original study 
by Weiskopf and Eger 11 compared isoflurane and desflurane 
which vary significantly in their solubility in blood. Lockwood 
and White took Weiskopf and Eger’s methods and compared 
isoflurane, desflurane, and sevoflurane. They used actual patient 
data in a closed and open circuit system and compared it to a 
computer model. In the first part of their discussion, they predict 

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ratio of liquid anesthetic used at FGF rates of 4, 2, 1, and 0.2 L/
min. The authors used their data to create ratio of liquid anes-
thetic used comparing desflurane to sevoflurane. Unfortunately 
they did not mention the acquisition cost or formula used 
to determine cost. Lockwood and White concluded that the 
ratios of usage shown are invariable and can always be used to 
determine relative expense. Lockwood and White found in an 
open circuit system the cost of desflurane and sevoflurane are 
approximately the same, but in a closed circuit system (greater 
rebreathing of exhaled gases) desflurane is slightly less expen-
sive than sevoflurane. Clinical correlation of these findings is 
desflurane becomes less expensive than sevoflurane and more 
cost effective as FGF rates are decreased. Lower FGF rates essen-
tially make an open circuit system closer to a closed system by 
decreasing gases added and removed from the system and thus 
requiring more rebreathing of exhaled gases. 

vaporizer dial Setting
Puckett and Andrews 12 in 1997 calculated the cost of sevo-

flurane, desflurane, and isoflurane using the vaporizer dialed 
percent setting, the volume percent equation, The mL of vapor 
per mL liquid calculation, and the cost per mL of liquid VAA. 
The volume percent equation was used to calculate the amount 
of vapor produced at 1 MAC and a FGF rate of 2 L/min. The 
vapor produced by one mL of VAA was calculated using the mL 
of vapor per mL liquid equation 

Volume % = [Vapor Flow Rate/(FGF + Vapor Flow Rate)] x 100

The authors were then able to convert the amount of vapor 
into mL of VAA, and then they used the cost per mL to deter-
mine cost per hour. The authors assumed that the vaporizer dial 
setting accurately denotes the concentration of vapor being deliv-
ered. The authors did not establish calibration of the vaporizers 
pre-measurement nor confirmed accurate delivery output. They 
compared the cost of sevoflurane and desflurane at the same 
flow rate and found sevoflurane to be slightly less expensive.12 



Although these authors premise that actual consumptive use 
dictates cost, they did not allow for differences in FGF rates for 
the agents. Fixed 2 L per minute FGF rate negates the real world 
clinical decision making of lowering FGF rates and the use of low 
flow anesthesia.

dion’s formula
In 1992 in a letter to the editor Dion stated a formula for 

directly measuring the cost of inhaled anesthetic incorporating 
the ideal gas law.13 The cost of an anesthetic agent can be calcu-
lated from the concentration (%) of gas delivered, FGF (L/min), 
duration of inhaled anesthetic delivery (min), molecular weight 
(MW in g), cost per mL (in dollars), a conversion factor, 2412, 
to account for the molar volume of a gas at 21ºC (24.12 L), and 
density (D in g/mL). The formula is as follows: 

Cost ($) = [(Concentration)(FGF)(Duration)(MW)(Cost/mL)] 
    [(2412)(D)]

Dion’s formula incorporates ideal gas law in order to convert 
mL VAA vapor into mL of VAA liquid, which is then used to 
determine cost using the acquisition price per mL. In order to 
convert volume of vapor into an mL of VAA, the density and 
molecular weight are used to convert the VAA vapor into moles, 
and moles are subsequently converted into mL of liquid VAA 
using a conversion factor of 2412. According to the universal gas 
law equation, one mole of an ideal gas at one atmosphere pres-
sure and corresponding to 21ºC will liberate 24.12 liters of vapor. 

Dion’s formula does not take into account patient specific 
uptake and distribution but rather amount of delivered inhaled 
agent. The amount of vapor actually consumed determines cost, 
which makes Dion’s formula a reliable method in cost calcula-
tion. Additionally, the incorporation of FGF rate better repre-
sents real world use of different FGF rates for different VAAs. 
Seven articles were found in the literature search using Dion’s 
formula, and all five supported sevoflurane as a more economical 

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inhalation agent than desflurane.6,12,14-18 Unfortunately, compari-
sons were made using similar FGF rates for each VAA. 

loke’s formula
Loke and Shearer, in a letter to the editor in 1993, questioned 

the use of Dion’s formula in newer volatile agents.19 They used 
Dion’s original formula and incorporated the ideal gas law 
directly into the formula rather than using a conversion factor of 
2412 for 24.12 Liters, which represents molar volume of gas at 
one atmosphere at 21ºC. 

For comparison purposes:

 Loke’s Formula 

Cost per MAC hour ($) =   [(MAC)(FGF)(60min)(MW)(Cost/mL)] 
      [(Pressure/(RT))(D)]

Dion’s Formula

Cost per MAC hour ($) =   [(MAC)(FGF)(60min)(MW)(Cost/mL)] 
       [(2412)(D)]

These formulas are similar; however with Loke’s formula the 
user would substitute the atmospheric temperature in Pascals, the 
ideal gas law constant (R) 8.314, and temperature (T) in Kelvin 
for the constant 2412. Loke and Shearer also included the cost 
of carrier gases nitrous oxide and oxygen for comparisons of 
Halothane, Enflurane, and Isoflurane. Unfortunately, desflurane 
and sevoflurane were unavailable in Australia at the time of this 
publication and comparison of these agents was not conducted. 

dIscussIon

Determining cost of VAA is a difficult task, made even more 
challenging by the various methods available to determine cost. 
Of the seven methods discovered in the literature, six were found 



to be either impractical or inaccurate. Weighing vapors is impos-
sible to replicate in a busy operating room setting.4 The computer 
data log method5 and four compartment model methods10,11 do 
not disclose cost calculation, making it difficult to determine 
accuracy. A simple comparison of MAC6 does not factor in 
important variables such as FGF and differences in VAA prop-
erties. Using the volume percent calculation is inaccurate since 
it is based on a dialed concentration and not an actual concen-
tration determined by a gas analyzer.12 Loke’s formula includes 
atmospheric pressure and temperature making it a more specific 
version of Dion’s formula but not necessarily a more accurate on 
because cost comparison would likely occur at the same facility 
and the atmospheric pressure and temperature would remain 
relatively constant. Thus, the use of Loke’s formula is unnec-
essarily complicated. Dion’s formula, in addition to being the 
most referenced method for calculating cost in the literature, is 
easily performed mathematically, accurate, and reproducible. As 
stated by Weinberg et al “this method is a simple pharmacoeco-
nomic tool that can be used by every anesthetist.”15p853 For these 
supporting reasons Dion’s method was utilized in the creation of 
a resource iApp tool. 

The majority of the literature supports sevoflurane6,12,14,15-18 

as the most cost effective agent using similar FGF rates.
(Table 1) Three studies supported cost effectiveness of 
desflurane.4,5,10(Table 2) Several articles advocate the use of low 
FGF rates4,5,14,16, however only one16 makes a case for comparing 
each agent at each agent’s lowest allowable FGF rates. Currently 
in the United States the FDA recommends FGF rate no less than 
1 L/min for cases less than 2 MAC hours and FGF 2 L/min for 
cases longer than 2 MAC hours for sevoflurane.20 Desflurane 
has no restrictions on FGF rate and may be administered with 
FGF as low as 0.5 L/min. The comparison of sevoflurane and 
desflurane at lowest allowable FGF rates is the most accurate 
method in determining true cost in clinical practice. Two of the 
seven studies that favored sevoflurane as most cost effective 



with similar FGF rates favored desflurane as the more cost effec-
tive agent when the lowest allowable FGF were used compared 
for cases less than two MAC hours (Table 3), and three studies 
favored desflurane when comparing cases longer than 2 MAC 
hours (Table 4). The impact of FGF rates and the cost savings of 
low flow anesthesia is emphasized by these tables.

Conclusions that one drug is more or less cost effective than 
another cannot always be translated from one region to another 
because of the variability in drug acquisition cost and avail-
ability of generic formulations (eg, Sevoflurane). Therefore in 
some institutions sevoflurane may be less expensive than desflu-
rane and in others the opposite may hold true. Using Dion’s 
formula, a cost comparison was made using acquisition prices 
in California and in Florida 2010. The variability in cost across 
regions and FGF is evident in the following examples. 

In California, the cost of sevoflurane was $0.38/ml and the 
cost of desflurane was $0.61/ml (known to author). Using Dion’s 
formula, a comparison was made at lowest allowable flow rates 
for cases less than 2 MAC hours. For cases less than two MAC 
hours, sevoflurane was cheaper to administer than desflurane at 
lowest allowable FGF rates. 

VAA MAC % FGF cost/bottle ml/bottle cost/ml  cost/min Cost/MAC hr

Sevo 2% 1 L/min  $93.93 250 ml  $0.38  $0.04  $2.46 

Des 6% 0.5 L/
min

 $147.00 240 ml  $0.61  $0.09  $5.30 

For cases longer than 2 MAC hours, FGF for sevoflurane must 
be increased from 1 L/min to 2 L/min. In this example, sevoflu-
rane is still slightly less expensive to administer than desflurane. 

VAA MAC 
%

FGF cost/bottle ml/bottle cost/ml cost/min Cost/MAC hr



Sevo 2% 2 L/min  $  93.93 250 ml  $0.38  $0.08  $4.92 

Des 6% 0.5 L/min  $ 147.00 240 ml  $0.61  $0.09  $5.30 

In Florida, the cost of sevoflurane was $0.64/ml and the cost 
of desflurane was $0.55/ml (known to author). Using Dion’s 
formula, a comparison was made at lowest allowable FGF rates 
for cases less than 2 MAC hours. For cases less than two MAC 
hours, sevoflurane was less expensive to administer than desflu-
rane at lowest allowable FGF rates.

VAA MAC 
%

FGF cost/
bottle

ml/bottle cost/ml cost/min Cost/MAC hr

Sevo 2% 1 L/min  $ 159.50 250  $0.64  $0.07  $4.18 

Des 6% 0.5 L/min  $ 133.00 240  $0.55  $0.08  $4.79 

However, for cases longer than 2 MAC hours, FGF for sevo-
flurane must be increased from 1 L/min to 2 L/min. In this 
case, sevoflurane was much more expensive to administer than 
desflurane. 

VAA MAC 
%

FGF cost/bottle ml/bottle cost/ml cost/min Cost/MAC hr

Sevo 2% 2 L/min  $ 159.50 250  $0.64  $0.14  $8.35 

Des 6% 0.5 L/min  $ 133.00 240  $0.55  $0.08  $4.79 

In accordance with Dion’s formula, nurse anesthetists are able 
to decrease cost of any VAA agent by using low FGF rates.

AdvAntAges of Low fLow AnestHesIA

Desflurane and sevoflurane have low blood gas solubility coef-
ficients that make them ideal for use with low flow anesthesia. 
Through the use of these insoluble agents the anesthetist is 
able to maintain tight control of the anesthetic depth. The low 

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solubility permits rapid changes in the depth of anesthesia and 
also provides a greater economy at low FGF rates.20 Up to 90% 
of the administered dose of inhaled anesthetic escapes unused 
nto the atmosphere.21 Low-flow anesthesia allows rebreathing, 
which conserves the amount of VAA used. Low-flow anesthesia 
also conserves patient’s body temperature, maintains inspired 
humidity, and minimizes environmental pollution. The nurse 
anesthetist primarily controls the immediate cost of the inhaled 
agent through control of the FGF rate.21

dIsAdvAntAges of Low fLow AnestHesIA

Anesthesia professionals may choose not to incorporate low 
FGF (low flow anesthesia) because of fears related to anesthetic 
complications. These fears may include difficulty controlling 
depth of anesthesia, accidental hypoxic events, hypercapnea, 
and the potential for toxic trace gases.21 An important disadvan-
tage with the use of low flow anesthesia is the risk of hypoxia 
due to the dilution if inspired gases by exhaled oxygen depleted 
gases. Higher delivered FiO2 is required to off set the dilution 
of inspired gases by rebreathing. Fears related to hypoxia and 
hypercapnea are mitigated with the use of gas analyzers and 
pulse oximetry. The newer VAAs sevoflurane and desflurane have 
low blood gas solubilities which make them easier for anesthesia 
providers to titrate and maintain an adequate depth of anes-
thesia. With low flow anesthesia the anesthesia provider must 
remain vigilant and monitor the patient’s hemodynamics closely. 
Low flow anesthesia is not recommended when gas must enter 
and leave a patient’s body quickly, as in induction and emer-
gence. During induction it is common practice to induce with 
an intravenous agent such as propofol and then deliver a given 
percent of VAA throughout a case. Consistent FGF and VAA 
delivery percent make calculation of cost easy. Frequent variable 
FGF rates and delivered VAA percent make ongoing calculation 
more labor intensive and time consuming but possible. 



tHere’s An App for tHAt!
In order to simplify the cost calculation of a particular VAA use 

an iApp for cellular smart phones was developed.          

 

This iApp, The CRNA iVAC, incorporates Dion’s formula 
which accounts for gas behaviors expressed in the ideal gas law. 
The ideal gas law (Universal gas law) expresses the relationship 
of pressure, volume, and temperature of a gas and is necessary 
when calculating the cost of any VAA. This cost calculation tool 
addresses the shortcoming of previous literature in which FGF 
rate were ignored or defaulted to the same FGF rate in calcula-
tions. The previous literature confuses the clinician as to the true 
cost of a particular VAA. The CRNA iVAC incorporates the 
necessary factors to calculate the cost of a particular VAA anes-
thetic. Direct comparison of one VAA to another is quickly and 
easily accomplished with this iApp. The CRNA iVAC dispels 
misconceptions regarding the perceived cost of VAAs and exem-
plifies the cost savings advantage of using low flow anesthesia. 

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concLusIon

The primary clinical determinates of cost is actual delivery 
concentration of a particular VAA and the FGF rate. VAA 
percent delivered is dictated to a large extent by patient needs 
but FGF rate is fully adjustable by the nurse anesthetist. When 
considering all variables involved in VAA cost of use, FGF rate 
is the most easily manipulated and efficient cost savings factor 
available for nurse anesthetists. Using the CRNA iVAC the 
following generalities regarding VAA cost can be made:

1. Isoflurane cost is inexpensive.
2. At 2L/min FGF rate for both agents, sevoflurane was consistently  

less expensive than desflurane.
3. Generic offers cost savings compared to brand VAAs. 
4. Low flow anesthesia (low FGF rate) for each agent maximizes  

cost savings for that particular agent.

Although improved outcomes have not been shown from low 
flow anesthesia, cost effectiveness remains a clinical achievement 
with this delivery technique. Actual VAA cost is determined by 
actual consumption and the CRNA iVAC quickly determines 
actual VAA cost. 

references

1 Meyer T. Managing inhaled anesthesia: challenges from a 
health-system pharmacist’s perspective. American Journal 
of Health-System Pharmacy. 2010;67:S4-S8. 

2 Walker JR. What is new with inhaled anesthetics: part 1. 
Journal of PeriAnesthesia Nursing. 1996;11(5):330-333.

3 Odin I, Feiss P. Low flow and economics of inhala-
tional anesthesia. Balliere’s Best Practice in Clinical 
Anesthesiology. 2005;19:399-413. 

4 Boldt J, Jaun N, Kumle B, Heck M, Mund K. Economic 
considerations of the use of anesthetics: a comparison 
of propofol, sevoflurane, desflurane, and isoflurane. 
Anesthesia and Analgesia. 1998;86:504-509. 



5 Cobos FV II, Haider H, Barrera A, Tinker J. Computerized 
tracking and comparative cost analysis of sevoflurane and 
desflurane [abstract]. Anesthesiology. 2007;107:A1108. 
http://www.asa-abstracts.com/strands/asaabstracts/abstract.
htm;jsessionid=1EFA35CFFD03F53FDC6692BD1514
1CC6?year=2007&index=8&absnum=1748. Accessed 
December 10, 2010. 

6 Traynor K. Inhaled anesthetics present cost-saving oppor-
tunity. American Journal of Health-System Pharmacy. 
2009;66:606-607. 

7 Eger EI. Cost in several flavors. International Anesthesia 
Research Society. 2010;110(2):276-277.

8 Eger EI. A brief history of the origin of minimum 
alveolar concentration (MAC). Anesthesiology. 
2002;96(1):238-239.

9 Eger EI, Saidman LJ, Brandstate B. Minimum alveolar 
anesthetic concentration: a standard of anesthetic potency. 
Anesthesiology. 1965;26(6):756-763.

10 Lockwood GG, White DC. Measuring the costs of 
inhaled anaesthetics. British Journal of Anaesthesia. 
2001;87(4):559-563. 

11 Weiskopf RB, Eger EI. Comparing the costs of inhaled 
anesthetics. Anesthesiology. 1993;79(6):1413-1418. 

12 Puckett SD, Andrews JJ. Sevoflurane use in veterans affairs 
medical centers: utility, safety, and cost-effectiveness. 
Journal of the American Association of Nurse Anesthetists. 
1997;65(2):136-142. 

13 Dion P. The cost of anaesthetic vapors. Canada Journal of 
Anaesthesia. 1992;39(6):633. 

14 Jellish WS, Owen K, Edelstein S, Fluder E, Leonetti JP. 
Standard anesthetic technique for middle ear surgical 
procedures: a comparison of desflurane and sevoflu-
rane. Otolaryngology and Head and Neck Surgery. 
2005;133(2):269-274.

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15 Weinberg L, Story D, Nam J, McNicols L. 
Pharmacoeconomics of volatile inhalational anaesthetic 
agents: an 11-year retrospective analysis. Anaesthesia and 
Intensive Care. 2010; 38(5)849-854. 

16 Golembiewski J. Economic considerations in the use of 
inhaled anesthetic agents. American Journal of Health-
System Pharmacy. 2010;67:S9-S12. 

17 Chernin EL. Pharmacoeconomics of inhaled anesthetic 
agents: considerations for the pharmacist. American 
Journal of Health-System Pharmacy. 2004;61(suppl 
4):S18-S22.

18 Lubarsky DA, Vigoda MM, Wagner DS. Economic and 
safety considerations of fast-acting inhaled anesthetics. 
Formulary. 2007;42:1-6. 

19 Loke J, Shearer WAJ. Cost of anaesthesia. Canada Journal 
of Anaesthesia. 1993;40(5):472-474. 

20 Ultane (sevoflurane) volatile liquid for inhalation. Food 
and Drug Administration. From http://www.accessdata.
fda.gov/drugsatfda_docs/label/2006/020478s016lbl.pdf. 
Accessed 8/31/2012.

21 Suttner S, Boldt J. Low-flow anaesthesia: Does it 
have potential pharmacoeconomic consequences? 
Pharmacoeconomics.2000;6:585-590.


