[Implementation of new standards in anaesthesia. Exemplified by the ad hoc introduction of desflurane in 10 German hospitals].
BACKGROUND
According to numerous pharmacoeconomic studies new anaesthesia techniques can improve recovery times and thus can have a positive economic impact on patient turnover. However, artificial study protocols do not always match real world situations and thus the practical impact of such studies remains unclear.


METHODS
At 10 hospitals exclusively using sevoflurane as a volatile anaesthetic, the ad hoc implementation of desflurane was studied with respect to post-anaesthetic recovery times (primary endpoint) and postoperative outcome measured by the Quality of Recovery Score- (QoR-)40, on the first postoperative day was investigated. Randomization of patients undergoing elective surgical procedures under general anaesthesia with sevoflurane (n=186) or desflurane (n=176) was started immediately after a period of a few days after introducing the new drug to all participants. Except for the volatile anaesthetic the anaesthetic procedure was performed according to local standing operating procedures.


RESULTS
All parameters indicating the immediate postanaesthetic recovery were superior in the patients receiving desflurane (mean±SD). Time to extubation was accelerated from 8.7±9.7 to 6.2±6.8 min. Times to recalling name and date of birth were accelerated by 2.6 and 3.8 min, respectively. Transferring the patients from the operating theatre to the post-anaesthetic recovery unit was 17.3±11.5 min after sevoflurane and 13.7±7.8 min after anaesthesia with desflurane. Eligibility for discharge according to a modified Aldrete score (White and Song 1999) was reached after 103±98 and 79±76 min, respectively. The postoperative recovery (QoR 40 questionnaire) did not differ 24 h later.


CONCLUSIONS
The implementation of a new drug (here: desflurane to substitute sevoflurane) can improve speed of recovery immediately after termination of anaesthesia even after a very short period of introducing the new technique but has no positive long term effects. Thus, the results of this trial performed under a real world scenario (health service research) without tight standardization by an artificial study protocol supports the results originating from randomized controlled clinical trials.
Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg, Baldingerstrasse, Marburg, Germany. eberhart@staff.uni-marburg.de
L H J
LH
Eberhart
H
H
Gerlach
R
R
Knaber
T
T
Koch
A M
AM
Morin
F
F
Röhr
S
S
Wagner
H
H
Wulf
M
M
Zoremba
D000293:Adolescent; D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000592:standards*; D000762:Anesthesia Recovery Period; D000776:Anesthesiology / Q000592:standards*; D018685:Anesthetics, Inhalation; D000077335:Desflurane; D004363:Drug Utilization; D023381:Endpoint Determination; D005260:Female; D005858:Germany; D006761:Hospitals; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010351:Patient Discharge; D057766:Policy; D000077149:Sevoflurane; D012959:Socioeconomic Factors; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane