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ANESTHETIC PHARMACOLOGY

Airway Reflexes Return More Rapidly After Desflurane Anesthesia Than After Sevoflurane Anesthesia

Rachel Eshima Mckay, MD^*, Mary Jane C. Large, RN, BSN, Michel C. Balea, MS^*, and Warren R. Mckay, MD^*

Departments of *Anesthesia and Perioperative Care, and Nursing, University of California, San Francisco, California

Address correspondence and reprint requests to Dr. Eshima Mckay, Department of Anesthesia, C-450, University of California, San Francisco, CA 94143-0648. Address e-mail to eshimar{at}anesthesia.ucsf.edu.

Patients given a more soluble inhaled anesthetic usually take longer to awaken from anesthesia than do patients given a less soluble anesthetic. In the present study, we tested whether such a delay in awakening was also associated with a delay in restoration of protective airway reflexes. Patients were randomly assigned to receive desflurane (n = 31) or sevoflurane (n = 33) via a laryngeal mask airway. Demographics did not differ between groups. The average minimum alveolar anesthetic concentration fraction for both groups was 0.62, and the mean (±sd) minimum alveolar anesthetic concentration hours was 1.00 ± 0.68 for desflurane versus 0.95 ± 0.57 for sevoflurane, although more patients given sevoflurane also received regional anesthesia (17 for sevoflurane and 8 for desflurane). The time from stopping anesthetic administration to appropriate response to command was longer after sevoflurane (5.5 ± 3.1 versus 3.4 ± 1.9 min; P < 0.01). In addition, the time from first response to command to ability to swallow 20 mL of water without coughing or drooling was longer after sevoflurane. At 2 min after responding to command, all patients given desflurane were able to swallow without coughing or drooling, whereas 55% of patients given sevoflurane coughed and/or drooled (P < 0.001). At 6 min after responding to command, 18% of patients given sevoflurane still could not swallow without coughing or drooling (P < 0.05). We conclude that desflurane allows an earlier return of protective airway reflexes.

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