Faster wash-out and recovery for desflurane vs sevoflurane in morbidly obese patients when no premedication is used

Colla, Luca La; Albertin, A.; Colla, G. La; Mangano, Alberto

doi:10.1093/bja/aem197

Cited by 84 publications

(55 citation statements)

References 27 publications

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“…The low solubility of desflurane may provide faster wash-in compared with the wash-out of sevoflurane, maintaining an adequate depth of anesthesia during the changing period. 31 Nevertheless, the gas analyzer may not always indicate accurate concentrations of volatile anesthetics when more than one agent is present; therefore, the use of a BIS monitor is recommended when changing from sevoflurane to desflurane.…”

Section: Discussionmentioning

confidence: 99%

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Mikuni

Harada

Yakushiji

et al. 2015

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Mikuni

Harada

Yakushiji

et al. 2015

Can J Anesth/J Can Anesth

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“…[13][14][15][16][17][18] We observed a statistically significant difference in time required for eye opening between the two treatment groups (weighted mean difference [WMD]: -3.10 min; 95% CI: -5.13 to -1.08). Patients who received desflurane required a significantly shorter time for eye opening than patients who received sevoflurane.…”

Section: Desflurane Vs Sevofluranementioning

confidence: 91%

“…In seven trials, desflurane was compared with sevoflurane for maintenance of anesthesia. 3,[13][14][15][16][17][18] Two studies compared the recovery profiles of patients given sevoflurane vs isoflurane for maintenance of anesthesia. 19,20 Another two studies compared the recovery parameters of patients given intravenous anesthesia with those given propofol and inhalational anesthesia.…”

Section: 13-22mentioning

confidence: 99%

“…Three studies used acceptable methods of randomization, 17,18,20 and four studies clearly described the method of allocation concealment. 3,13,20,21 Three studies did not mention the blinding procedure, 15,19,22 and only one reported no blinding of the outcome assessors. 18 Eight studies incorporated an intention-to-treat analysis, 3,13,15,16,[18][19][20]22 and in all trials, an acceptable number of patients (\ 20%) withdrew during the follow-up periods .…”

Section: 13-22mentioning

confidence: 99%

“…Seven RCTs compared recovery outcomes of patients given desflurane vs sevoflurane for maintenance of anesthesia, 3,[13][14][15][16][17][18] and six trials evaluated the time required for eye opening. [13][14][15][16][17][18] We observed a statistically significant difference in time required for eye opening between the two treatment groups (weighted mean difference [WMD]: -3.10 min; 95% CI: -5.13 to -1.08).…”

Section: Desflurane Vs Sevofluranementioning

confidence: 99%

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Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials

Liu

Cherng

Chen

et al. 2015

Can J Anesth/J Can Anesth

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Purpose Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia.Source We systematically searched the PubMed, EMBASE TM , Cochrane, and Scopus TM databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). Principal findings We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] -3.10 min; 95% confidence interval (CI): -5.13 to -1.08), to squeeze the investigator's hand (WMD -7.83 min; 95% CI: -8.81 to -6.84), to be prepared for tracheal extubation (WMD -3.88 min; 95%

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Perioperative care of the obese patient

Carron

Fakhr

Ieppariello

et al. 2020

British Journal of Surgery

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Background Obesity has become an increasing problem worldwide during the past few decades. Hence, surgeons and anaesthetists will care for an increasing number of obese patients in the foreseeable future, and should be prepared to provide optimal management for these individuals. This review provides an update of recent evidence regarding perioperative strategies for obese patients. Methods A search for papers on the perioperative care of obese patients (English language only) was performed in July 2019 using the PubMed, Scopus, Web of Science and Cochrane Library electronic databases. The review focused on the results of RCTs, although observational studies, meta‐analyses, reviews, guidelines and other reports discussing the perioperative care of obese patients were also considered. When data from obese patients were not available, relevant data from non‐obese populations were used. Results and conclusion Obese patients require comprehensive preoperative evaluation. Experienced medical teams, appropriate equipment and monitoring, careful anaesthetic management, and an adequate perioperative ventilation strategy may improve postoperative outcomes. Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery.

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Faster wash-out and recovery for desflurane vs sevoflurane in morbidly obese patients when no premedication is used

Abstract: Desflurane provides faster wash-in and wash-out than sevoflurane in morbidly obese patients, and recovery is much faster after desflurane administration when no premedication has been used.

Cited by 84 publications

References 27 publications

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study

Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials

Perioperative care of the obese patient

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