title: The effect of anaesthetic agents on induction, recovery and patient preferences in adult day case surgery: a 7-day follow-up randomized controlled trial.
abstract: OBJECTIVE
  To compare induction, pre- and post-discharge recovery characteristics and patient preferences between four anaesthetic regimens in adult day-surgery.
  
  
  METHODS
  Randomized controlled trial. In all, 1158 adults assigned to: propofol induction and maintenance, propofol induction with isoflurane/N2O, or sevoflurane/N2O maintenance, or sevoflurane/N2O alone. We prospectively recorded induction and pre-discharge recovery characteristics, collected 7-day post-discharge recovery characteristics using patient diaries and patient preferences by telephone follow-up.
  
  
  RESULTS
  Recruitment rate was 73%--of the 425 refusals, 226 were not willing to risk a volatile induction. During induction, excitatory movements and breath holding were more common with sevoflurane only (P < 0.01). Injection pain and hiccup were more common with propofol induction (P < 0.01). In the recovery room and the postoperative ward, both nausea and vomiting were more common with sevoflurane only (P < 0.01). This difference disappeared within 48 h. There was no difference between groups in the mental state on awakening, recovery time, time to discharge or overnight admissions; then was also no difference in pain between the four groups for each of the seven postoperative days (P < 0.01), nor any differences in concentration or forgetfulness. Patients took 6.5 days (95% CI: 6.0-7.0, n = 693) to resume normal activities. Patients who received sevoflurane only were more likely to recall an unpleasant induction and least likely to want the same induction method again (P < 0.01).
  
  
  CONCLUSIONS
  Differences in outcome between the four regimens are transient; sevoflurane is not an ideal sole agent for adult day case anaesthesia and, in this setting, patients base their preferences for future anaesthetics on the method of induction.
authors.affiliation: Wirral Hospital Trust, Cheshire, Manchester, UK. julia.moore@whnt.nhs.uk
authors.forename: J K
authors.initials: JK
authors.lastname: Moore
authors.forename: R A
authors.initials: RA
authors.lastname: Elliott
authors.forename: K
authors.initials: K
authors.lastname: Payne
authors.forename: E W
authors.initials: EW
authors.lastname: Moore
authors.forename: A S
authors.initials: AS
authors.lastname: St Leger
authors.forename: N J N
authors.initials: NJ
authors.lastname: Harper
authors.forename: B J
authors.initials: BJ
authors.lastname: Pollard
authors.forename: J
authors.initials: J
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D000777:Anesthetics / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D009609:Nitrous Oxide / Q000008:administration & dosage; D011184:Postoperative Period; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D012119:Respiration; D000077149:Sevoflurane; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000777:Anesthetics; D008738:Methyl Ethers; D000077149:Sevoflurane; D007530:Isoflurane; D009609:Nitrous Oxide; D015742:Propofol