Anesthesia, Surgery
Conditions
Keywords
Induction, Coughing, Anesthesia
Brief summary
Goals for ambulatory surgery include providing optimal surgical conditions while ensuring a rapid early recovery without side effect. Dexter et al1 concluded in a meta-analysis that Desflurane can reduce the extubation time when compared to Sevoflurane. This potential benefit of Desflurane can be especially attractive in short ambulatory cases performed with general anesthesia with a laryngeal mask airway. Although some studies have not shown a difference on perioperative cough and laryngospasm between Desflurane and Sevoflurane at clinically relevant doses.It has been reported in the literature that Desflurane causes cough4 and many providers avoid using Desflurane with a LMA (laryngeal mask airway) in the ambulatory setting. In this study we will also evaluate, as a secondary outcome, the presence and severity of perioperative cough and laryngospasm. Previous investigators have demonstrated a more rapid resumption of normal daily activities after ambulatory surgery in patients anesthetized with Desflurane when compared with Sevoflurane.these investigators suggested a better quality of recovery when Desflurane is used probably due to a lower lipid solubility of Desflurane. We will also evaluate quality of recovery as a secondary outcome using a validated instrument. Significance: 1. A more rapid awakening, especially, in a fast and high turnover cases that are performed with LMA can lead to a more cost effective utilization of operating room time 2. It has been reported that Desflurane causes more cough than Sevoflurane and Anesthesiologists avoid using Desflurane with LMA cases, this study will reinforce that there is no difference.
Interventions
DRUGDesflurane
Administratino of Desflurane
Administration of Sevoflurane
Sponsors
Northwestern University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
* Age 18-65 * Female patients undergoing outpatient gynecologic and breast surgery * Under general anesthesia using an LMA * ASA I,II,
Exclusion criteria
* Patients on CNS depressants * Chronic opioid use * Corticosteroid * Pregnant patients * Full stomach * Morbidly obese (BMI \>35kg/m2) * Hepatitis B * Hepatitis C * Coronary artery disease * Liver disease * Renal disease * Seizure disorder Dropout criteria: * Need for endotracheal tube * Surgeon or patient request * Hospital admission
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Time to Awakening | Time inhalational agent is turned off to time of patient awakening |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants Who Coughed | Perioperative | — |
| Quality of Recovery 40 | 1 day | Survey completion at 24 hours post surgery of the Quality of Recovery 40 questionnaire.This questionnaire asks 40 questions in 5 categories of recovery. The scores are combined from each group and are used as a composite score. The scores range from a low of 40 to a high of 200. A score of 40 would indicate a poor quality of recovery where as a score of 200 would be a good quality of recovery at 24 hours postoperative. |
Countries
United States
Participant flow
Recruitment details
85 Subjects were recruited and randomized and 80 completed the study. Subjects were consecutively enrolled from December 2010 through February 2012.
Participants by arm
| Arm | Count |
|---|---|
| Desflurane Administration of Desflurane | 43 |
| Sevoflurane Administration of Sevoflurane | 42 |
| Total | 85 |
Baseline characteristics
| Characteristic | Sevoflurane | Desflurane | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 42 Participants | 43 Participants | 85 Participants |
| Age Continuous | 39.9 years STANDARD_DEVIATION 7.7 | 41.2 years STANDARD_DEVIATION 8.3 | 40.6 years STANDARD_DEVIATION 8.1 |
| Region of Enrollment United States | 42 participants | 43 participants | 85 participants |
| Sex: Female, Male Female | 42 Participants | 43 Participants | 85 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 2 / 40 | 1 / 40 |
| serious Total, serious adverse events | 0 / 40 | 0 / 40 |
Outcome results
Primary
Time to Awakening
Time frame: Time inhalational agent is turned off to time of patient awakening
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Desflurane | Time to Awakening | 6.8 Elapsed time in minutes |
| Sevoflurane | Time to Awakening | 11.8 Elapsed time in minutes |
Secondary
Number of Participants Who Coughed
Time frame: Perioperative
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Desflurane | Number of Participants Who Coughed | 4 participants |
| Sevoflurane | Number of Participants Who Coughed | 7 participants |
Secondary
Quality of Recovery 40
Survey completion at 24 hours post surgery of the Quality of Recovery 40 questionnaire.This questionnaire asks 40 questions in 5 categories of recovery. The scores are combined from each group and are used as a composite score. The scores range from a low of 40 to a high of 200. A score of 40 would indicate a poor quality of recovery where as a score of 200 would be a good quality of recovery at 24 hours postoperative.
Time frame: 1 day
Population: In the Desflurane group 35 completed the survey 24 hours postoperative where as 33 in the Sevoflurane completed the survey during the postoperative period.
| Arm | Measure | Value (MEDIAN) |
|---|---|---|
| Desflurane | Quality of Recovery 40 | 188 score (between 40 low-200 high) |
| Sevoflurane | Quality of Recovery 40 | 182 score (between 40 low-200 high) |