title: Airway reactions and emergence times in general laryngeal mask airway anaesthesia: a meta-analysis.
abstract: BACKGROUND
  Desflurane's short emergence time supports fast track anaesthesia. Data on the rate of upper airway complications and emergence time when desflurane is used with laryngeal mask airway (LMA) are controversial and limited.
  
  
  OBJECTIVE
  To compare recovery time variables and the rates of upper airway adverse events in patients with an LMA undergoing general surgery with desflurane, sevoflurane, isoflurane or propofol anaesthesia.
  
  
  METHODS
  A systematic review and meta-analysis of randomised controlled trials (RCTs).
  
  
  METHODS
  A systematic search for eligible RCTs in Embase (Elsevier) and in PubMed (National Library of Medicine) databases up to September 2013.
  
  
  METHODS
  RCTs investigating the rates of cough overall, cough at emergence, laryngospasm, time to eye opening, time to removal of the LMA, time to respond to command and time to state date of birth in patients with an LMA, during emergence from desflurane, sevoflurane, isoflurane or propofol anaesthesia.
  
  
  RESULTS
  Thirteen RCTs were included and analysed. We found a strong interstudy variability. There was no difference in the rates of upper airway events between desflurane and sevoflurane or between desflurane and a control group consisting of all the other anaesthetics combined. Comparing desflurane (n = 284) with all other anaesthetic groups (n = 313), the risk ratio [95% confidence interval (95% CI)] was 1.12 (0.63 to 2.02, P = 0.70). Cough at emergence was only measured in patients receiving desflurane (n = 148) and sevoflurane (n = 146): the risk ratio (95% CI) was 1.49 (0.55 to 4.02, P = 0.43). Laryngospasm was rare and there was no significant difference in its incidence when desflurane (n = 262) was compared with all other anaesthetics combined (n = 289; risk ratio 1.03; 95% CI 0.33 to 3.20, P = 0.96). The times of all emergence variables were significantly faster in the desflurane group than in all other groups.
  
  
  CONCLUSIONS
  When using an LMA, upper airway adverse reactions in association with desflurane anaesthesia were no different from those noted with sevoflurane, isoflurane or propofol anaesthesia. Emergence from general anaesthesia with desflurane is significantly faster than all the other anaesthetics. Due to interstudy variations and the small size of the trials, further large-scale, multicentre studies are required to confirm or refute the results of this meta-analysis.
authors.affiliation: From the Department of Anaesthesiology, University Hospital RWTH Aachen, Aachen (AS, RR, MC), Department of Anaesthesiology and Intensive Care Medicine, Martha-Maria Hospital, Halle (HGF), Department of Anaesthesiology, University Hospital Ulm, Ulm (GF), Department of Anaesthesiology and Intensive Care Medicine, Harzklinik Hospital, Goslar (JH), Department of Anaesthesiology and Intensive Care Medicine, Klinikum am Steinenberg, Reutlingen (FKP), and Department of Anaesthesiology and Intensive Care Medicine, Klinikum Links der Weser, Bremen, Germany (PHT).
authors.forename: Ana
authors.initials: A
authors.lastname: Stevanovic
authors.forename: Rolf
authors.initials: R
authors.lastname: Rossaint
authors.forename: Harald G
authors.initials: HG
authors.lastname: Fritz
authors.forename: Gebhard
authors.initials: G
authors.lastname: Froeba
authors.forename: Joern
authors.initials: J
authors.lastname: Heine
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Puehringer
authors.forename: Peter H
authors.initials: PH
authors.lastname: Tonner
authors.forename: Mark
authors.initials: M
authors.lastname: Coburn
mesh_terms: D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D003371:Cough / Q000453:epidemiology / Q000209:etiology; D000077335:Desflurane; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D017214:Laryngeal Masks; D007826:Laryngismus / Q000453:epidemiology / Q000209:etiology; D008738:Methyl Ethers / Q000008:administration & dosage / Q000009:adverse effects; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D000077149:Sevoflurane
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane; D015742:Propofol