costs of anesthesia care
Did you ever see the movie 2001, A Space Odyssey? Besides being known for giving us Ric Flair’s entrance music, it is also known as a visionary film. Made in 1968 in the midst of the Apollo Program’s efforts to land on the moon, one of the signature scenes is aboard a commercial space plane traveling from Earth to a space station. You see, in 1968, it did not seem far-fetched that by the end of the century humankind would have such things—space ports and scientific bases on the moon and maybe even Mars.
Why do we mention this? Because it shows how difficult it is to predict the future. Unless we missed the news report, we are still waiting for a base on the moon or a human trip to Mars. In the 1960s, those things seemed like they would have been a certainty 40 or 50 years later. So in this chapter, we are not going to predict what is in the future, but we will discuss some of the things that are already in use (in the section The Future is Now) or things that have been tested in the area of anesthesia equipment (in the section Not Anytime Soon).
We say the future is now because there are some things that are already in limited use but have not fully penetrated the anesthesia equipment market. As is often the case, it takes a while for some new things to catch on or to prove their worth. This is how it was for pulse oximetry and capnography a generation ago. The automated record is another example of something that is readily available for purchase and use but is not universally used by anesthesia practitioners.
Xenon is supposed to be the next big thing in anesthesia. This noble gas has many properties of the ideal inhalational agent. It is already in use clinically in Russia and Germany. In this section, we will not discuss the pharmacology and physiologic concerns of xenon but will focus on issues involving its supply and delivery.
The big problem with xenon is its rarity and its expense. You may recall that xenon is found in our atmosphere but in a very small concentration (0.0000087%, or 1 part per 11.5 million). In fact, the amount of xenon being produced each year currently is only enough for less than half a million anesthetics. It takes a lot of energy to separate 1 L of xenon from the atmosphere.
At the time this book is being written, 1 L of xenon in the United States costs $10 to $12 or so. Even with a closed-circuit technique and rebreathing, a xenon anesthetic would be expensive. Administration ...