title: An analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in ophthalmic surgery: a retrospective study.
abstract: BACKGROUND
  Anesthetic techniques can contribute to reduction of anesthesia-controlled time to improve operating room (OR) efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total IV anesthesia (TIVA) and desflurane anesthesia (DES) techniques for ophthalmic surgery under general anesthesia.
  
  
  METHODS
  We performed a retrospective analysis using hospital databases to compare the anesthesia-controlled times of ophthalmic surgery patients receiving either TIVA via target-controlled infusion with propofol/fentanyl or desflurane/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (surgical time, incision to surgical completion and application of dressings; anesthesia time, start of anesthesia to extubation; extubation time, surgery complete and dressings applied to extubation; time in OR, arrival in the OR to departure from the OR; postanesthetic care unit (PACU) stay time, arrival in the PACU to discharge from the PACU to the general ward; and total surgical suite time, arrival in the OR to discharge from the PACU to the general ward) that comprise a patient's hospital stay and the incidence of postoperative nausea and vomiting were compared between the 2 anesthetic techniques.
  
  
  RESULTS
  We included data from 1405 patients, with 595 patients receiving TIVA and 810 receiving DES. The extubation time was faster (TIVA-DES = -1.85 minutes, 99.2% confidence interval [CI], -2.47 to -1.23 minutes) and the PACU stay time was shorter (TIVA-DES = -3.62 minutes, 99.2% CI, -6.97 to -0.10 minutes) in the TIVA group than in the DES group. However, there was no significant difference in total surgical suite time between groups (TIVA-DES = -5.03 minutes, 99.2% CI, -11.75 to 1.69 minutes). We performed the random-effects analyses while stratifying for procedure and showed that the extubation time in the TIVA group was faster by 14% (99.2% CI, 9% to 19%, P < 0.0001) relative to the DES group, and the PACU stay time was faster by 5% (99.2% CI, 1% to 10%, P = 0.002). Significantly fewer patients suffered postoperative nausea and vomiting and required rescue therapy in the TIVA group than in the DES group (11.3% vs 32.2%, risk difference 21.0%, 95% CI, 16.9% to 25.1%, P < 0.001 and 23.9% vs 54.0%, risk difference 30.1%, 95% CI, 18.3% to 42.0%, P = 0.002, respectively).
  
  
  CONCLUSIONS
  In our hospital, the use of TIVA reduced the mean time to extubation by at least 9% and PACU stay time by more than 1% when compared with the use of DES anesthesia for ophthalmic surgery.
authors.affiliation: From the *Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei; †Department of Anesthesiology, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung; ‡School of Public Health, National Defense Medical Center, Taipei; §Graduate Institute of Life Sciences, National Defense Medical Center, Taipei; and ∥Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan, Republic of China.
authors.forename: Zhi-Fu
authors.initials: ZF
authors.lastname: Wu
authors.forename: Guan-Shiung
authors.initials: GS
authors.lastname: Jian
authors.forename: Meei-Shyuan
authors.initials: MS
authors.lastname: Lee
authors.forename: Chin
authors.initials: C
authors.lastname: Lin
authors.forename: Yi-Fang
authors.initials: YF
authors.lastname: Chen
authors.forename: Yi-Wen
authors.initials: YW
authors.lastname: Chen
authors.forename: Yuan-Shiou
authors.initials: YS
authors.lastname: Huang
authors.forename: Chen-Hwan
authors.initials: CH
authors.lastname: Cherng
authors.forename: Chueng-He
authors.initials: CH
authors.lastname: Lu
mesh_terms: D000328:Adult; D000368:Aged; D060666:Airway Extubation; D000762:Anesthesia Recovery Period; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D000077335:Desflurane; D005260:Female; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D061646:Operative Time; D013508:Ophthalmologic Surgical Procedures; D010351:Patient Discharge; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D012189:Retrospective Studies; D013997:Time Factors; D013996:Time and Motion Studies
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol