Use of Desflurane for Outpatient Anesthesia A Comparison with Propofol and Nitrous Oxide

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Desflurane's induction and recovery characteristics were compared to those of propofol–nitrous oxide in outpatients undergoing laparoscopic procedures. Ninety-two healthy patients were randomized to receive either: 1) propofol induction and propofol-nitrous oxide maintenance (control), 2) propofol induction and desfluranenitrous oxide maintenance, 3) desflurane–nitrous oxide, or 4) desflurane alone for induction and maintenance of anesthesia. Inhalational induction with desflurane–nitrous oxide was faster than with desflurane alone (100 ± 35 vs. 124 ± 43 s). Inhalation inductions were associated with a high incidence of apnea (17 and 26%), breathholding (26 and 39%), and coughing (30 and 22%) in groups 3 and 4, respectively. The emergence time after discontinuation of desflurane in oxygen (4.5 ± 2.1 min.) was significantly less than that after propofol–nitrous oxide (7.3 ± 3.9 min.). However, times from arrival in the recovery room until the patients were judged fit for discharge were similar for all four treatment groups. Digit–symbol substitution test results and sedation visual analogue scores also were similar during the first 2 h in the recovery room. A lower incidence of moderate-to-severe nausea was reported in group 1 (15% vs. 52, 52, and 59% in groups 2, 3, and 4, respectively). In conclusion, induction of anesthesia with desflurane was rapid but is associated with a high incidence of airway irritation. Emergence and recovery profiles after maintenance of anesthesia with desflurane compared favorably to a propofol–nitrous oxide combination. However, propofol was associated with a lower incidence of nausea than was desflurane after outpatient anesthesia for laparoscopic surgery.

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