Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence

Ramachandiran Ramya; Venkata Ganesh; Naik Naveen; GY Srinivasa; Ajay Singh; Tanvir Samra; Ishwar Bhukal

doi:10.5114/jcb.2025.158427

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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abstract:

Original article

Isoflurane as a cost-effective alternative to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial of emergence

Ramachandiran Ramya

¹

,

Venkata Ganesh

¹

,

Naik B. Naveen

¹

,

GY Srinivasa

²

,

Ajay Singh

¹

,

Tanvir Samra

¹

,

Ishwar Bhukal

¹

Department of Anaesthesia and Intensive Care, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
Department of Radiotherapy and Oncology, Post-Graduate Institute of Medical Education and Research, Chandigarh, India

J Contemp Brachytherapy 2025; 17, 6

DOI: https://doi.org/10.5114/jcb.2025.158427

Online publish date: 2025/12/31

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AMA

Ramya R, Ganesh V, Naveen NB, et al. Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence. Journal of Contemporary Brachytherapy. 2025. doi:10.5114/jcb.2025.158427.

APA

Ramya, R., Ganesh, V., Naveen, N. B., Srinivasa, G., Singh, A.,  & Samra, T. et al. (2025). Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence. Journal of Contemporary Brachytherapy. https://doi.org/10.5114/jcb.2025.158427

Chicago

Ramya, Ramachandiran, Venkata Ganesh, Naik B Naveen, GY Srinivasa, Ajay Singh, Tanvir Samra,  and Ishwar Bhukal. 2025. "Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence". Journal of Contemporary Brachytherapy. doi:10.5114/jcb.2025.158427.

Harvard

Ramya, R., Ganesh, V., Naveen, N., Srinivasa, G., Singh, A., Samra, T.,  and Bhukal, I. (2025). Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence. Journal of Contemporary Brachytherapy. https://doi.org/10.5114/jcb.2025.158427

MLA

Ramya, Ramachandiran et al. "Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence." Journal of Contemporary Brachytherapy, 2025. doi:10.5114/jcb.2025.158427.

Vancouver

Ramya R, Ganesh V, Naveen N, Srinivasa G, Singh A, Samra T et al. Isoflurane as a cost-effective alternative 
to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial 
of emergence. Journal of Contemporary Brachytherapy. 2025. doi:10.5114/jcb.2025.158427.

Purpose
The optimal anaesthetic choice for gynaecological brachytherapy remains uncertain. While sevoflurane offers rapid recovery due to favourable pharmacokinetics, its higher cost limits affordability in resource-constrained settings. Isoflurane, a less expensive volatile agent, may be a cost-effective alternative if recovery profiles are comparable.

Material and methods
We conducted a prospective, randomised, non-inferiority trial including 100 women with American Society of Anesthesiologists (ASA) physical status I-III undergoing ambulatory intracavitary brachytherapy. Participants were randomly allocated to maintenance anaesthesia with either isoflurane (n = 50) or sevoflurane (n = 50), with anaesthetic depth titrated to maintain a bi-spectral index (BIS) between 40 and 60. The primary outcome was emergence time, defined as the interval from discontinuation of anaesthesia to eye opening after verbal command. Secondary outcomes included time to supraglottic airway removal, haemodynamic stability, postoperative cognitive function, post-anaesthesia care unit (PACU) stay, adverse events, and anaesthetic agent cost. Non-inferiority was prespecified with a margin of 3.2 minutes.

Results
Emergence times were similar between isoflurane and sevoflurane groups (7.13 ±1.60 min vs. 7.24 ±1.70 min; mean difference 0.12 min; 97.5% CI: 0.86 to –0.63), confirming non-inferiority of isoflurane. Secondary outcomes, including airway removal time, haemodynamics, cognitive scores, PACU stay and adverse events, showed no significant differences. Isoflurane administration cost was 61.6% lower compared to sevoflurane (22.2 ±2.77 INR vs. 57.8 ±9.35 INR; p = 0.001).

Conclusions
Isoflurane is non-inferior to sevoflurane for emergence time in short-duration gynaecological brachytherapy, with comparable recovery profiles. Its substantial cost advantage supports its use as an economical anaesthetic option in high-volume, resource-limited oncology settings.

keywords:

Isoflurane as a cost-effective alternative to sevoflurane for short-duration gynaecological brachytherapy: a randomised non-inferiority trial of emergence

Ramachandiran Ramya 1 , Venkata Ganesh 1 , Naik B. Naveen 1 , GY Srinivasa 2 , Ajay Singh 1 , Tanvir Samra 1 , Ishwar Bhukal 1

anaesthesia, brachytherapy, costs and cost analysis, isoflurane, sevoflurane

Ramachandiran Ramya

¹

,

Venkata Ganesh

¹

,

Naik B. Naveen

¹

,

GY Srinivasa

²

,

Ajay Singh

¹

,

Tanvir Samra

¹

,

Ishwar Bhukal

¹