title: The effect of sevoflurane versus desflurane on the incidence of upper respiratory morbidity in patients undergoing general anesthesia with a Laryngeal Mask Airway: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA).
  
  
  METHODS
  Systematic review and meta-analysis of randomized controlled trials (RCTs).
  
  
  METHODS
  Operating room of an academic medical center.
  
  
  METHODS
  A systematic review of RCTs of patients receiving general anesthesia with a LMA was performed. Sevoflurane and desflurane were used for maintenance of anesthesia in the RCTs. A wide search was performed to identify RCTs comparing desflurane with sevoflurane on the incidence of upper respiratory adverse events in patients undergoing surgery with a LMA. The primary outcomes were incidence of cough and laryngospasm. A random-effects model was used to perform quantitative analysis.
  
  
  RESULTS
  Data originating from 7 studies comprising 657 subjects were analyzed. The confidence interval (CI) was large relative to a clinically significant difference in the incidence of overall cough and laryngospasm in patients receiving desflurane versus sevoflurane (odds ratio [OR; 95% CI] of 1.44 [0.49 - 4.1] and 3.06 [0.43 - 21.62]), respectively. The incidence of cough at emergence was greater in subjects receiving desflurane compared with sevoflurane (OR [95% CI] of 2.43 [1.2 - 4.7], number needed to harm [NNH] = 9.0); however, the analysis was limited by the presence of an asymmetric funnel plot suggesting the possibility of publication bias.
  
  
  CONCLUSIONS
  There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.
authors: Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. Electronic address: G-jr@northwestern.edu.
authors: Gildasio S
authors: GS
authors: de Oliveira
authors: Walter
authors: W
authors: Girao
authors: Paul C
authors: PC
authors: Fitzgerald
authors: Robert J
authors: RJ
authors: McCarthy
mesh_terms: D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D003371:Cough / Q000139:chemically induced / Q000453:epidemiology; D000077335:Desflurane; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000009:adverse effects / Q000031:analogs & derivatives*; D017214:Laryngeal Masks / Q000009:adverse effects*; D007826:Laryngismus / Q000139:chemically induced / Q000453:epidemiology; D008738:Methyl Ethers / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012120:Respiration Disorders / Q000139:chemically induced*; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane
keywords: Airway management; Anesthesia emergence; Coughing, intraoperative; Laryngeal Mask Airway; Laryngospasm; Upper airway adverse events