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

• Published in: Journal of clinical anesthesia Vol. 25; no. 8; pp. 651 - 658
• Main Authors: De Oliveira, Gildasio S., Fitzgerald, Paul C., Ahmad, Shireen, Marcus, R. Jay, McCarthy, Robert J.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.12.2013; Elsevier; Elsevier Limited
• Subjects: Adult; Airway management; Ambulatory Surgical Procedures; Analgesics, Opioid - adverse effects; Analgesics, Opioid - pharmacology; Anesthesia; Anesthesia Recovery Period; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Combined - adverse effects; Anesthetics, Combined - pharmacology; Anesthetics, Inhalation - adverse effects; Anesthetics, Inhalation - pharmacology; Awakening from anesthesia; Biological and medical sciences; Cough - chemically induced; Desflurane; Double-Blind Method; Female; Fentanyl - adverse effects; Fentanyl - pharmacology; Gas flow; Hospitals; Humans; Hysteroscopy; Isoflurane - adverse effects; Isoflurane - analogs & derivatives; Isoflurane - pharmacology; Kaplan-Meier Estimate; Laryngeal Masks; Medical sciences; Methyl Ethers - adverse effects; Methyl Ethers - pharmacology; Middle Aged; Morbidity; Narcotics; Pain; Pain Medicine; Pharyngitis - chemically induced; Postoperative Complications - chemically induced; Prospective Studies; Recovery from surgery; Sevoflurane; Surgery; Sevoflurane; Recovery from surgery; Desflurane; Awakening from anesthesia; Agonist; μ Opioid receptor; Fentanyl; Opiates; Narcotic analgesic; Recovery; Respiratory tract; Randomization; Surgery; Quality; Anesthesia; Larynx; Ambulatory; Halogen Organic compounds; Volatile compound; Human; Mask; General anesthetic; Double blind study; Awakening; Phenylpiperidine derivatives
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2013.07.006

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. Randomized, double-blinded, placebo-controlled clinical trial. Ambulatory surgery unit of a university hospital. 80 subjects receiving general anesthesia for outpatient gynecological surgery using a LMA. Desflurane/fentanyl or sevoflurane/fentanyl were used for anesthetic maintenance. 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. 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). 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.