BACKGROUND Propofol accounts for a substantial proportion of medication waste. Evidence-based waste reduction methods are scarce. METHODS In a retrospective analysis of 331 procedures, the total propofol waste per surgery was compared between manual and syringe pump induction of anaesthesia during total intravenous anaesthesia (TIVA), with a syringe pump used to maintain TIVA after induction. The secondary endpoint was the amount of propofol administered. Subgroup analyses examined the influence of biological sex, age, weight or BMI, American Society of Anesthesiologists (ASA) physical status, substance use, and anaesthesia duration on propofol waste. RESULTS Syringe pump induction was associated with 32.8% less waste of propofol (P<0.001); this effect was most pronounced in procedures lasting 20-60 min (up to 46.9% less in procedures lasting 20-40 min, P<0.001) and 80-120 min (up to 48.8% less in procedures lasting 100-120 min, P=0.003). The amount of waste was not affected by biological sex, age, weight, BMI, or ASA physical status. Syringe pump induction was consistently associated with less waste, except in patients with obesity. Patients with active substance use had 27.6% more waste with manual induction (P=0.031) but not with syringe pump induction. In patients with and without active substance use, syringe pump induction resulted in less waste (substance use: 48.7% less, P=0.0015; without substance use: 22.7% less, P=0.0045). CONCLUSIONS Syringe pump induction reduced propofol waste during TIVA, regardless of patient characteristics. Manual induction using a separate syringe should be reconsidered from an environmental and economic viewpoint. CLINICAL TRIAL REGISTRATION DRKS00032518I.

中文翻译：

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手动和注射泵诱导全静脉麻醉对异丙酚废物的影响：单中心回顾性分析。


背景 异丙酚占药物浪费的很大一部分。基于证据的减少废物的方法很少。方法 在对 331 例手术的回顾性分析中，比较了全静脉麻醉 （TIVA） 期间手动和注射泵诱导麻醉与诱导后用于维持 TIVA 的注射泵之间每次手术的总异丙酚废物。次要终点是异丙酚的给药量。亚组分析检查了生理性别、年龄、体重或 BMI、美国麻醉医师协会 （ASA） 身体状况、物质使用和麻醉持续时间对异丙酚废物的影响。结果 注射泵诱导与异丙酚浪费减少 32.8% 相关 （P<0.001）;这种影响在持续 20-60 min 的手术中最为明显 （在持续 20-40 min 的手术中减少高达 46.9%，P<0.001） 和 80-120 分钟 （在持续 100-120 min 的手术中减少高达 48.8%，P = 0.003）。废物量不受生理性别、年龄、体重、BMI 或 ASA 身体状况的影响。注射泵诱导始终与较少的废物相关，肥胖患者除外。使用活性物质的患者在手动诱导组 （P=0.031） 的废物增加 27.6%，但使用注射泵组则没有。在有和没有使用活性物质的患者中，注射泵诱导导致更少的废物 （物质使用：减少 48.7%，P=0.0015;没有物质使用：减少 22.7%，P=0.0045）。结论 注射泵诱导减少了 TIVA 期间异丙酚的浪费，无论患者特征如何。应从环境和经济角度重新考虑使用单独注射器进行手动诱导。临床试验注册 DRKS00032518I。