In women undergoing laparoscopic tubal sterilization with a MAC
technique, the anesthetic drug costs were found to be significantly reduced
relative to general anesthesia (US $21 vs $46,
respectively).81 The MAC technique was also associated
with less time in the OR, a higher degree of alertness on the evening of the
day of surgery, as well as decreased postoperative pain (33% vs 80%)
and sore throats (3% vs 70%), contributing to a significant reduction
in the overall perioperative costs. Patel and coworkdes82
reported that the use of MAC sedation resulted in a 6- to 7-min decrease in
OR exit time compared with general anesthesia with desflurane, contributing
to enhanced turnover of cases. Similarly, comparative studies involving
general endotracheal anesthesia, central neuroaxial blockade, and MAC
techniques for inguinal herniorrhaphy (Table 11–5)83 and anorectal (Table
11–6)84 procedures have consistently found improved
recovery profiles, decreased side effects, greater patient satisfaction, and
reduced anesthetic costs with MAC.83–85 More recent
studies86–88involving outpatients undergoing orthopedic
procedures have also found superior recovery profiles with PNB compared with
those for general anesthesia, contributing to a more favorable cost–benefit
profile. The use of topical local anesthetics has also offered significant
advantages for outpatients undergoing ophthalmologic (eg,
cataract)66 and plastic (eg, facial laser resurfacing)
surgery procedures.89 The effect of the anesthetic
technique on cost and recovery time is an increasingly important
consideration in today's clinical practice environment because of the heavy
emphasis on “fast-tracking” recovery processes.