Surgery
Conditions
Brief summary
The investigators thus propose a comparative effectiveness quality improvement project to evaluate the feasibility of switching from near-exclusive use of isoflurane in adult general surgical patients to Desflurane.
Detailed description
The three available volatile anesthetics appear to be comparably safe. However, higher solubility slows emergence from isoflurane and sevoflurane compared to Desflurane. Even a few minutes delay in emergence from anesthesia has financial implications since institutional costs of operating room time can easily be $30 per minute. Postoperative care is also expensive. Furthermore, in busy hospitals such as the Cleveland Clinic, inadequate recovery throughput frequently delays surgery. The investigators thus propose a comparative effectiveness quality improvement project to evaluate the feasibility of switching from near-exclusive use of isoflurane in adult general surgical patients to Desflurane. (The investigators will exclude children because there are compelling clinical reasons to use sevoflurane in pediatric patients.) The proposed comparison is between isoflurane (our current routine) and Desflurane which is no longer used at the Clinic because of price concerns - a decision that that did not consider down-stream effects, including prolonged emergence and recovery.
Interventions
DRUGDesflurane
General anesthesia with desflurlane
DRUGIsoflurane
General anesthesia with isoflurane
Sponsors
The Cleveland Clinic
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
SINGLE (Subject)
Masking description
Patients will not be told which type of volatile anesthetic they received.
Intervention model description
Randomized cluster cross-over trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adults having general anesthesia in the G operating room suite at the Cleveland Clinic Main Campus.
Exclusion criteria
* Operations lasting \<1.5 hours.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Duration of post-anesthesia care unit recovery | 1 hour | Time from entry to the post-anesthesia to discharge from unit. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Duration of anesthetic emergence | 1 hour | Time from a MAC fraction of 0.3 (presumably shortly after volatile anesthesia is discontinued) and extubation. |
| Cost of post-anesthesia care unit. | 2 hours | Cost of post-anesthesia unit care. To be estimated only if there is a substantial difference between the groups. |
| Delirium | 5 days | Incidence of postoperative delirium. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORAllen Keebler, D.O.
The Cleveland Clinic
Outcome results
None listed