Improving cost-efficiency at a hospital by showing the time-saving effect of using different neuromuscular blockers for short operations

Muscle relaxants are used in anaesthesia to obtain adequate muscle relaxation for intubation and operations. A goal of hospital management is to improve the hospital's budget by selecting adequate neuromuscular blocking agents for short-term operations. A basic investigation was conducted of the time required to reach maximal blocking (MB) with administration of atracurium and rocuronium during anaesthesia induction and recovery time (RT). Patients were divided into random groups. Group R received rocuronium 0.6 mg/kg IV and group A received atracurium 0.5 mg/kg IV. Time required to reach MB and RT was measured with a train-of-four (TOF) device where MB and RT were named TOF0 and TOF75 respectively. Direct expenses were used to evaluate the effect on hospital budget. Mean times calculated to reach TOF75 in recovery with rocuronium and atracurium were 38 and 51 min respectively. Mean durations of operations where atracurium and rocuronium were used were 47 and 46 min respectively. In group R, patients reached TOF75 before the operation time and eventually extubated safely. In group A, the time to reach TOF75 was 51 min but operation time was 46 min and patients needed an additional 5 min for recovery and safe extubation. Preparation period was determined as 14 min. These results indicate that 60 min in group R and 65 min in group A were needed from the start of one operation to the start of the next. This study showed that if a hospital's usage ratio is 100% performance capacity, and there are no other problems, in 1 month by using rocuronium it could perform an extra 15 paediatric surgical operations gaining additional income of US$2436 for one operation room per month.