Desflurane and sevoflurane comparable for ambulatory anesthesia
MedWire News: Researchers report that desflurane and sevoflurane for maintenance of anesthesia do not differ with regard to times to discharge and patients return to normal daily activities.
Paul White (University of Texas Southwestern Medical Center, Dallas, USA) and colleagues note that, as has been previously demonstrated, emergence after discontinuation of anesthesia was faster with desflurane than sevoflurane, but the current findings indicate that this difference does not impact on the later recovery endpoints.
The team randomly assigned 130 outpatients undergoing superficial surgical procedures requiring general anesthesia to receive maintenance anesthesia with either sevoflurane 1% to 3% or desflurane 3% to 8% in an air/oxygen mixture. All the patients were induced with propofol, 2 mg/kg intravenously.
The inspired concentration of the volatile anesthetic was varied to maintain hemodynamic stability and a bispectral index value of 50 to 60.
Emergence from anesthesia was faster with desflurane, with eye opening occurring at 5 minutes compared with 8 minutes for those receiving desflurane. The corresponding times for responds to commands and orientation were 6 versus 9 minutes, and 8 versus 11 minutes.
Nevertheless, all patients achieved the fast-track recovery criteria, with a score of at least 12, before leaving the operating room.
The two groups were similar with regard to times to sitting, tolerating fluids, standing, and ambulating alone.
White and co-workers note that, although 60% of patients receiving desflurane reported resuming normal activities of daily living on postoperative day 1 compared with 48% of those receiving sevoflurane, the difference was not statistically significant.
The two groups were also comparable with regard to the incidence of coughing during the administration of the volatile anesthetics, although there was a significantly higher incidence during the peri-operative period in patients receiving desflurane, at 60% compared with 32% for the sevoflurane group.
Overall, 95% to 97% of patients in both groups were highly satisfied with their anesthesia experience.
White et al conclude in the journal Anesthesia and Analgesia: “Both volatile anesthetics should be available to clinicians for use in ambulatory anesthesia.”
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By Lucy Piper