Desflurane/fentanyl compared with sevoflurane/fentanyl on awakening and quality
of recovery in outpatient surgery using a laryngeal mask airway: a randomized,
double-blinded controlled trial.
Author(s): De Oliveira GS Jr(1), Fitzgerald PC(2), Ahmad S(2), Marcus RJ(2), McCarthy RJ(2).
Affiliation(s): Author information:
(1)Department of Anesthesiology, Northwestern University Feinberg School of
Medicine, Chicago, IL 60611, USA. Electronic address: g-jr@northwestern.edu.
(2)Department of Anesthesiology, Northwestern University Feinberg School of
Medicine, Chicago, IL 60611, USA.
Publication date & source: 2013, J Clin Anesth. , 25(8):651-8
STUDY OBJECTIVE: To compare time to awakening and upper airway morbidity between
desflurane and sevoflurane using a Laryngeal Mask Airway (LMA) and a balanced
anesthetic regimen inclusive of opioids.
DESIGN: Randomized, double-blinded, placebo-controlled clinical trial.
SETTING: Ambulatory surgery unit of a university hospital.
PATIENTS: 80 subjects receiving general anesthesia for outpatient gynecological
surgery using a LMA.
INTERVENTIONS: Desflurane/fentanyl or sevoflurane/fentanyl were used for
anesthetic maintenance.
MEASUREMENTS: Patients were randomly assigned to receive desflurane or
sevoflurane. The primary outcome was time to awakening as determined by an
observer who was blinded to study group allocation. Secondary outcomes included
the frequency of sore throat, cough, and pain perioperatively and at 2 and 24
hours postoperatively. Quality of recovery (QoR; via QoR-40 questionnaire) at 24
hours also was determined.
MAIN RESULTS: The median (IQR) time to eye opening following desflurane was 6.8
(5.0 - 9.8) minutes versus 11.8 (8.8 - 14.6) minutes following sevoflurane (P <
0.001), or a difference of 5.0 (99% CI 2.3 - 6.8) minutes. The median difference
in response to verbal commands was 5.3 (99% CI 2.4 - 7.1) minutes. The frequency
of cough, laryngospasm, sore throat, and hoarseness did not differ between
groups. Quality of recovery at 24 hours was better in the desflurane group:
difference in medians 6 (99% CI 0 - 12; P = 0.003).
CONCLUSIONS: Desflurane retains faster awakening properties than does sevoflurane
when used in combination with fentanyl as part of anesthetic maintenance in
outpatient surgery with a LMA. The balanced anesthetic maintenance regimen seems
to reduce the potential airway reactivity properties of desflurane.
|