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ALEX MACARIO, M.D., M.B.A., is Associate Professor, Departments of Anesthesia and Health Research and Policy, Stanford University School of Medicine, Stanford, CA. FRANKLIN DEXTER, M.D., PH.D., is Associate Professor, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City. DAVID LUBARSKY, M.D., M.B.A., is Professor and Chair, Department of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami/Jackson Memorial Hospital, Miami, FL.

Address correspondence to Dr. Macario at the Department of Anesthesia, Stanford University School of Medicine, Stanford, CA 94305-5640 (amaca{at}stanford.edu).

Purpose. Results of published, randomized controlled trials comparing sevoflurane and desflurane were pooled to measure differences in times until patients obeyed commands, were extubated, were oriented, were discharged from the postanesthesia care unit (PACU), and were ready to be discharged to home, as well as the occurrence of postoperative nausea and vomiting (PONV). Methods. We reviewed all randomized clinical trials in MEDLINE through December 18, 2003, with a title or abstract containing the words sevoflurane and desflurane. Two reviewers independently extracted study data from papers that met inclusion criteria. Endpoints were pooled using random-effects meta-analysis. Results. Twenty-two reports of 25 studies (3 reports each described 2 studies) met our inclusion criteria. A total of 746 patients received sevoflurane, and 752 received desflurane. Patients receiving desflurane recovered 1–2 minutes quicker in the operating room than patients receiving sevoflurane. They obeyed commands 1.7 minutes sooner (p < 0.001; 95% confidence interval [CI], 0.7–2.7 minutes), were extubated 1.3 minutes sooner (p = 0.003; 95% CI, 0.4–2.2 minutes), and were oriented 1.8 minutes sooner (p < 0.001; 95% CI, 0.7–2.9 minutes). No significant differences were detected in the phase I or II PACU recovery times or in the rate of PONV. Conclusion. Meta-analysis of studies in which the duration of anesthesia was up to 3.1 hours indicated that patients receiving either desflurane or sevoflurane did not have significant differences in PACU time or PONV frequency. Patients receiving desflurane followed commands, were extubated, and were oriented 1.0–1.2 minutes earlier than patients receiving sevoflurane. Index terms: Anesthetics; Costs; Desflurane; Drug comparisons; Sevoflurane; Surgery; Toxicity

 

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