title: The effect of sevoflurane versus desflurane on postoperative catheter-related bladder discomfort in patients undergoing transurethral excision of a bladder tumour: a randomized controlled trial.
abstract: OBJECTIVE
  Catheter-related bladder discomfort (CRBD) due to an indwelling urinary catheter can cause postoperative distress, and the mechanism underlying CRBD is linked to the activation of muscarinic receptors. Inhalation of anesthetic agents, such as sevoflurane and desflurane, has differential inhibitory effects on muscarinic receptors. We aimed to compare the effect of intraoperative sevoflurane vs desflurane inhalation on postoperative CRBD.
  
  
  METHODS
  Eighty-nine patients undergoing transurethral resection of a bladder tumour (TURBT) were randomly allocated to two groups. The sevoflurane group (n = 45) and the desflurane group (n = 44) received the respective inhalational agents for maintenance of general anesthesia. The incidence and severity (mild/moderate/severe) of CRBD were assessed at zero, one, six, and 24 hr postoperatively.
  
  
  RESULTS
  Catheter-related bladder discomfort during the first 24 hr postoperatively occurred in 34/45 (76%) patients receiving sevoflurane compared with 41/44 (93%) patients receiving desflurane [absolute difference 18%; 95% confidence interval [CI], 2 to 33; P = 0.039]. The differences in the rate of CRBD between the sevoflurane and desflurane groups at zero, one, and six hours postoperatively were 24% (95% CI, 7 to 40; P = 0.012), 33% (95% CI, 15 to 49; P = 0.001), and 26% (95% CI, 6 to 43; P = 0.019), respectively. The incidence of moderate to severe CRBD and the number of patients treated with tramadol for CRBD were comparable between the two groups.
  
  
  CONCLUSIONS
  As a maintenance agent of general anesthesia, sevoflurane reduced the incidence of early postoperative CRBD in patients undergoing TURBT when compared with desflurane. The protocol for this clinical trial was registered at ClinicalTrials.gov (NCT02096224).
authors.affiliation: Department of Anesthesiology and Pain Medicine, Keimyung University Dongsan Hospital, Keimyung University College of Medicine, Daegu, Korea.
authors.forename: Hyun-Chang
authors.initials: HC
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Won-Pyo
authors.initials: WP
authors.lastname: Hong
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Lim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. hppark@snu.ac.kr.
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000494:pharmacology; D000077335:Desflurane; D005260:Female; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000494:pharmacology; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000494:pharmacology; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D012720:Severity of Illness Index; D000077149:Sevoflurane; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage; D001749:Urinary Bladder Neoplasms / Q000601:surgery; D014546:Urinary Catheterization / Q000009:adverse effects*
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D014147:Tramadol; D000077335:Desflurane; D007530:Isoflurane