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AMBULATORY ANESTHESIA

Comparison of Recovery Profile After Ambulatory Anesthesia with Propofol, Isoflurane, Sevoflurane and Desflurane: A Systematic Review

Anil Gupta, MD FRCA, PhD^*,, Tracey Stierer, MD^*, Rhonda Zuckerman, MD^*, Neal Sakima, MD^*, Stephen D. Parker, MD^*, and Lee A. Fleisher, MD^* Section Editor

*Department of Anesthesiology and Critical Care, and the Division of Ambulatory Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland and the Division for Ambulatory Surgery, Department of Anesthesiology, University Hospital, Örebro, Sweden

Address correspondence and reprint requests to Anil Gupta, Department of Anesthesiology and Intensive Care, University Hospital, SE 701 85 Örebro, Sweden. Address email to anil_guptarca{at}hotmail.com

In this systematic review we focused on postoperative recovery and complications using four different anesthetic techniques. The database MEDLINE was searched via PubMed (1966 to June 2002) using the search words "anesthesia" and with ambulatory surgical procedures limited to randomized controlled trials in adults (>19 yr), in the English language, and in humans. A second search strategy was used combining two of the words "propofol," "isoflurane," "sevoflurane," or "desflurane". Screening and data extraction produced 58 articles that were included in the final meta-analysis. No differences were found between propofol and isoflurane in early recovery. However, early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane. A minor difference was found in home readiness between sevoflurane and isoflurane (5 min) but not among the other anesthetics. Nausea, vomiting, headache, and postdischarge nausea and vomiting incidence were in favor of propofol compared with isoflurane (P < 0.05). A larger number of patients in the inhaled anesthesia groups required antiemetics compared with the propofol group. We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics. The incidence of side effects, specifically postoperative nausea and vomiting, was less frequent with propofol.

IMPLICATIONS: A systematic analysis of the literature comparing postoperative recovery after propofol, isoflurane, desflurane, and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups. The incidence of nausea and vomiting were less frequent with propofol.

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