title: Airway reflexes return more rapidly after desflurane anesthesia than after sevoflurane anesthesia.
abstract: Patients given a more soluble inhaled anesthetic usually take longer to awaken from anesthesia than do patients given a less soluble anesthetic. In the present study, we tested whether such a delay in awakening was also associated with a delay in restoration of protective airway reflexes. Patients were randomly assigned to receive desflurane (n = 31) or sevoflurane (n = 33) via a laryngeal mask airway. Demographics did not differ between groups. The average minimum alveolar anesthetic concentration fraction for both groups was 0.62, and the mean (+/-sd) minimum alveolar anesthetic concentration hours was 1.00 +/- 0.68 for desflurane versus 0.95 +/- 0.57 for sevoflurane, although more patients given sevoflurane also received regional anesthesia (17 for sevoflurane and 8 for desflurane). The time from stopping anesthetic administration to appropriate response to command was longer after sevoflurane (5.5 +/- 3.1 versus 3.4 +/- 1.9 min; P < 0.01). In addition, the time from first response to command to ability to swallow 20 mL of water without coughing or drooling was longer after sevoflurane. At 2 min after responding to command, all patients given desflurane were able to swallow without coughing or drooling, whereas 55% of patients given sevoflurane coughed and/or drooled (P < 0.001). At 6 min after responding to command, 18% of patients given sevoflurane still could not swallow without coughing or drooling (P < 0.05). We conclude that desflurane allows an earlier return of protective airway reflexes.
authors.affiliation: Departments of *Anesthesia and Perioperative Care, and †Nursing, University of California, San Francisco, California.
authors.forename: Rachel Eshima
authors.initials: RE
authors.lastname: Mckay
authors.forename: Mary Jane C
authors.initials: MJC
authors.lastname: Large
authors.forename: Michel C
authors.initials: MC
authors.lastname: Balea
authors.forename: Warren R
authors.initials: WR
authors.lastname: Mckay
mesh_terms: D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000494:pharmacology*; D015992:Body Mass Index; D000077335:Desflurane; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000494:pharmacology*; D008297:Male; D008738:Methyl Ethers / Q000494:pharmacology*; D008875:Middle Aged; D012018:Reflex; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane
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