Studies of desflurane in outpatient anesthesia

Abstract

The low solubility of desflurane contributes to rapid emergence after outpatient anesthesia. Compared with isoflurane, recovery times to eye opening, response to verbal commands, and orientation to person, place, and time have been significantly shorter. Even when compared with the rapid, short-acting intravenous anesthetic propofol for induction and maintenance of outpatient anesthesia, desflurane displayed more favorable early recovery characteristics. Although patients receiving desflurane are less sedated in the early postoperative period than those receiving propofol, times to ambulation and discharge were similar. The direct "antiemetic" activity of propofol may have contributed to a lower incidence of postoperative nausea and emesis versus desflurane. Finally, the effects of desflurane, isoflurane, and propofol on postoperative psychomotor (e.g., Trieger test, choice reaction time) and cognitive (e.g., digit-symbol substitution test, critical flicker fusion test) function are remarkably similar. Given its favorable early recovery profile, desflurane would appear to be a useful alternative to both isoflurane and propofol for maintenance of outpatient anesthesia. As desflurane is pungent and possesses respiratory irritant properties, propofol will likely remain the induction agent of choice in the outpatient setting. In conclusion, desflurane appears to have few adverse effects on recovery after ambulatory surgery, but nausea and emesis were lower with propofol. Desflurane's relative ease of administration versus propofol may be an important determinant of its future role in outpatient anesthesia.