Adverse respiratory events with sevoflurane compared with desflurane in ambulatory surgery

Abstract

BACKGROUND An increasing number of studies have concluded that the number of adverse events in the upper airway caused by desflurane does not differ significantly from the number of adverse events caused by sevoflurane. The advantages of desflurane in ambulatory surgery should be reassessed. OBJECTIVES The aim of this study was to compare adverse respiratory events and recovery outcomes in patients undergoing desflurane or sevoflurane-based anaesthesia in ambulatory surgery. DESIGN A systematic review and meta-analysis of randomised controlled trials (RCTs). DATA SOURCES A systematic search for eligible RCTs in PubMed, Medline, Cochrane Central Register of Controlled Trials, ScienceDirect and Embase published up to June 2019. ELIGIBILITY CRITERIA RCTs investigating the occurrence of adverse respiratory events, including airway irritation, stridor, coughing, respiratory distress and laryngospasm, emergence agitation, postoperative nausea and vomiting (PONV), time to eye opening and time to discharge from the operation room after desflurane or sevoflurane-based anaesthesia. RESULTS Thirteen trials were included and analysed. A total of 634 patients were included in the desflurane group, and 633 patients in the sevoflurane group. The occurrence of respiratory complications was significantly higher with desflurane-based anaesthesia than with sevoflurane-based anaesthesia (Total n = 673, 20.0 vs. 12.8%, relative risk (RR) 1.59 (95% CI 1.15 to 2.20)) with low heterogeneity ( I 2 = 20%). There was no difference in the occurrence of emergence agitation (Total n = 626, 29.1 vs. 27.2%, RR 1.05 (95% CI 0.84 to 1.30)) or the incidence of PONV between the desflurane and sevoflurane groups (Total n = 989, 19.0 vs. 21.0%, RR 0.95 (95% CI 0.71 to 1.26)). Time to eye opening was significantly faster with desflurane than that with sevoflurane (Total n = 1072, mean difference = −3.32 min (95% CI −4.02 to −2.61)) with a substantial heterogeneity ( I 2 = 72.6%). There was no significant difference in the time to discharge from the operation room between the two groups (Total n = 1056, mean difference = −0.45 min (95% CI −5.89 to 4.99)). CONCLUSION Despite recent reports that there is no significant difference in adverse respiratory events between desflurane and sevoflurane, a pooled analysis revealed that desflurane resulted in a higher rate than sevoflurane. Therefore, the consequences of desflurane should not be neglected and its airway irritant properties should be taken into account. TRIAL REGISTRATION PROSPERO (CRD42019147939).

Risk assessment and optimization strategies to reduce perioperative respiratory adverse events in Pediatric Anesthesia—Part 2: Anesthesia‐related risk and treatment options

“…In one large cohort study, desflurane was associated with an increased rate of perioperative respiratory adverse events (RR 2.17 (95% CI 1.5–3.15) p < .0001) when compared to other inhalational agents 50 . Further, in a systematic review and meta‐analysis of 13 trials (3 pediatric) comparing sevoflurane to desflurane, the authors found that desflurane was associated with an increased rate (RR 1.59 (95% CI 1.15 to 2.20)) of respiratory complications such as laryngospasm and bronchospasm 51 . This difference, however, did not persist when analyzing subgroups such as children or patients in whom an endotracheal tube was used.…”

“…50 Further, in a systematic review and meta-analysis of 13 trials (3 pediatric) comparing sevoflurane to desflurane, the authors found that desflurane was associated with an increased rate (RR 1.59 (95% CI 1.15 to 2.20)) of respiratory complications such as laryngospasm and bronchospasm. 51 This difference, however, did not persist when analyzing subgroups such as children or patients in whom an endotracheal tube was used. Specifically, desflurane can lead to increased airway resistance and thus, in those with a history of URTI, or any other pulmonary disease associated with airway susceptibility, it should be avoided.…”

Comparison of the effects of dexmedetomidine and remifentanil on perioperative hemodynamics and recovery profile of patients undergoing laryngeal microsurgery

“…In addition, the possibility of drug-interaction with desflurane cannot be excluded. Especially, desflurane may induce increased HR and airway irritation [ 38 ] which may result in significant effects in our study. There was also another limitation in the research design.…”

The Effects of Switching from Sevoflurane to Short-Term Desflurane prior to the End of General Anesthesia on Patient Emergence and Recovery: A Randomized Controlled Trial

“…Among all the volatile anesthetics currently used, desflurane has the lowest blood solubility, suggesting the fastest induction and awakening [4]. Despite the advantage of faster recovery, even compared to sevoflurane, undesirable effects, including airway stimulation, tachycardia, and greenhouse effect, can limit the use of desflurane [16][17][18][19]. In such cases, sevoflurane can be mostly chosen for anesthesia induction and maintenance due to its little airway stimulation effect.…”