Use of desflurane for outpatient anesthesia. A comparison with propofol and nitrous oxide.
Desflurane's induction and recovery characteristics were compared to those of propofol-nitrous oxide in outpatients undergoing laparoscopic procedures. Ninety-two healthy patients were randomized to receive either: 1) propofol induction and propofol-nitrous oxide maintenance (control), 2) propofol induction and desflurane-nitrous oxide maintenance, 3) desflurane-nitrous oxide, or 4) desflurane alone for induction and maintenance of anesthesia. Inhalation induction with desflurane-nitrous oxide was faster than with desflurane alone (100 +/- 35 vs. 124 +/- 43 s). Inhalation inductions were associated with a high incidence of apnea (17 and 26%), breath-holding (26 and 39%), and coughing (30 and 22%) in groups 3 and 4, respectively. The emergence time after discontinuation of desflurane in oxygen (4.5 +/- 2.1 min.) was significantly less than that after propofol-nitrous oxide (7.3 +/- 3.9 min.). However, times from arrival in the recovery room until the patients were judged fit for discharge were similar for all four treatment groups. Digit-symbol substitution test results and sedation visual analogue scores also were similar during the first 2 h in the recovery room. A lower incidence of moderate-to-severe nausea was reported in group 1 (15% vs. 52, 52, and 59% in groups 2, 3, and 4, respectively). In conclusion, induction of anesthesia with desflurane was rapid but is associated with a high incidence of airway irritation. Emergence and recovery profiles after maintenance of anesthesia with desflurane compared favorably to a propofol-nitrous oxide combination. However, propofol was associated with a lower incidence of nausea than was desflurane after outpatient anesthesia for laparoscopic surgery.
Van Hemelrijck
J
J
Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri 63110.
Smith
I
I
White
P F
PF
D000328:Adult; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D000777:Anesthetics; D001794:Blood Pressure; D000077335:Desflurane; D004357:Drug Synergism; D006339:Heart Rate; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D010535:Laparoscopy; D008875:Middle Aged; D009609:Nitrous Oxide; D015742:Propofol
D000777:Anesthetics; D000077335:Desflurane; D007530:Isoflurane; D009609:Nitrous Oxide; D015742:Propofol