Meta-analysis of trials comparing postoperative recovery after anesthesia with sevoflurane or desflurane.
OBJECTIVE
Results of published, randomized controlled trials comparing sevoflurane and desflurane were pooled to measure differences in times until patients obeyed commands, were extubated, were oriented, were discharged from the postanesthesia care unit (PACU), and were ready to be discharged to home, as well as the occurrence of postoperative nausea and vomiting (PONV).


METHODS
We reviewed all randomized clinical trials in MEDLINE through December 18, 2003, with a title or abstract containing the words sevoflurane and desflurane. Two reviewers independently extracted study data from papers that met inclusion criteria. Endpoints were pooled using random-effects meta-analysis.


RESULTS
Twenty-two reports of 25 studies (3 reports each described 2 studies) met our inclusion criteria. A total of 746 patients received sevoflurane, and 752 received desflurane. Patients receiving desflurane recovered 1-2 minutes quicker in the operating room than patients receiving sevoflurane. They obeyed commands 1.7 minutes sooner (p < 0.001; 95% confidence interval [CI], 0.7-2.7 minutes), were extubated 1.3 minutes sooner (p = 0.003; 95% CI, 0.4-2.2 minutes), and were oriented 1.8 minutes sooner (p < 0.001; 95% CI, 0.7-2.9 minutes). No significant differences were detected in the phase I or II PACU recovery times or in the rate of PONV.


CONCLUSIONS
Meta-analysis of studies in which the duration of anesthesia was up to 3.1 hours indicated that patients receiving either desflurane or sevoflurane did not have significant differences in PACU time or PONV frequency. Patients receiving desflurane followed commands, were extubated, and were oriented 1.0-1.2 minutes earlier than patients receiving sevoflurane.
Macario
Alex
A
Departments of Anesthesia and Health Research and Policy, Stanford University School of Medicine, Stanford, CA 94305-5640, USA. amaca@stanford.edu
Dexter
Frankin
F
Lubarsky
David
D
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D002675:Child, Preschool; D000077335:Desflurane; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage* / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D008875:Middle Aged; D011182:Postoperative Care / Q000706:statistics & numerical data; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D011997:Recovery Room; D000077149:Sevoflurane; D013514:Surgical Procedures, Operative / Q000379:methods; D013997:Time Factors
D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane