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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.
MedLine Citation:
PMID:  24095885     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 was 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 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 an anesthetic maintenance in outpatient surgery with a LMA. The balanced anesthetic maintenance regimen seems to reduce potential airway reactivity properties of desflurane.
Authors:
Gildasio S De Oliveira; Paul C Fitzgerald; Shireen Ahmad; R Jay Marcus; Robert J McCarthy
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-3
Journal Detail:
Title:  Journal of clinical anesthesia     Volume:  -     ISSN:  1873-4529     ISO Abbreviation:  J Clin Anesth     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8812166     Medline TA:  J Clin Anesth     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2013 Elsevier Inc. All rights reserved.
Affiliation:
Department of Anesthesiology; Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. Electronic address: g-jr@northwestern.edu.
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