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AMBULATORY ANESTHESIA

Fast-Track Eligibility of Geriatric Patients Undergoing Short Urologic Surgery Procedures

Brian Fredman, MB BCh^*, Offer Sheffer, MD^*, Edna Zohar, MD^*, Irena Paruta, MD^*, Santiago Richter, MD, Robert Jedeikin, BSc MB ChB, FFA(SA)^*, and Paul F. White, PhD MD, FANZCA

Departments of *Anesthesiology and Intensive Care and Urology, Meir Hospital, Kfar Saba, Israel, and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and the Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas

Address correspondence and reprint requests to Brian Fredman, MB BCh, Department of Anesthesiology and Intensive Care, Meir Hospital, Kfar Saba 44281, Israel. Address e-mail to bdfgls{at}netvision.net.il

Our primary objective was to assess the feasibility of geriatric patients (>65 yr) bypassing the postanesthesia care unit (PACU) after ambulatory surgery. A secondary objective was to compare recovery profiles when using three different maintenance anesthetics. Ninety ASA physical status I–III consenting outpatients (>65 yr) undergoing short urologic procedures were randomly assigned to one of three anesthetic treatment groups. After a standardized induction with fentanyl and propofol, anesthesia was maintained with propofol (75–150 µg · kg^-1 · min^-1 IV), isoflurane (0.7%–1.2% end tidal), or desflurane (3%–6% end tidal), in combination with nitrous oxide 70% in oxygen. In all three groups, the primary anesthetic was titrated to maintain an electroencephalographic-bispectral index value of 60–65. Recovery times, postanesthesia recovery scores, and therapeutic interventions in the PACU were recorded. Although emergence times were similar in the three groups, the time to achieve a fast-track discharge score of 14 was significantly shorter in patients receiving desflurane compared with propofol and isoflurane (22 ± 23 vs 33 ± 25 and 44 ± 36 min, respectively). On arrival in the PACU, a significantly larger percentage of patients receiving desflurane were judged to be fast-track eligible compared with those receiving either isoflurane and propofol (73% vs 43% and 44%, respectively). The number of therapeutic interventions in the PACU was also significantly larger in the Isoflurane group when compared with the Propofol and Desflurane groups (21 vs 11 and 7, respectively). In conclusion, use of desflurane for maintenance of anesthesia should facilitate PACU bypass ("fast-tracking") of geriatric patients undergoing short urologic procedures.

IMPLICATIONS: Geriatric outpatients undergoing brief urologic procedures more rapidly achieve fast-tracking discharge criteria after desflurane (versus isoflurane and propofol) anesthesia. Use of isoflurane was also associated with an increased need for nursing interventions in the early recovery period compared with desflurane and propofol.

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