Comparisons between Desflurane and Isoflurane or Propofol on Time to Following Commands and Time to Discharge

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Abstract
Background: Anesthesiologists can best decide whether to use desflurane based on the magnitudes of its effects compared to other general anesthetics. The goal of this study was to estimate the mean decrease in times to following commands when desflurane was being used instead of isoflurane or propofol. The mean decrease in time to hospital discharge after ambulatory surgery when desflurane was used instead of propofol also was examined. Methods: Published studies that met entry criteria were collected up to November 1994. Included are studies in which patients were randomly assigned to groups, extubation was planned at the end of surgery, and general anesthesia was induced with an intravenous agent. We used random-effects metaanalysis to calculate confidence intervals for pooled mean differences. Results: Six studies (with 229 patients) that compared desflurane to propofol met the inclusion criteria. Eight studies (with 316 patients) compared desflurane to isoflurane. A statistically significant difference in the time to following commands after discontinuation of desflurane versus propofol (mean difference 0.7 min (propofol minus desflurane), 95% confidence interval -0.2 to 1.7 min) was not found. Patients who received propofol were discharged to home a mean of 17 min (4-30 min) more quickly than patients who received desflurane. Patients who received desflurane followed commands a mean of 4.4 min (3.3-5.4 min) more quickly than did patients who received isoflurane. Conclusions: There are only minor clinically important differences between desflurane and isoflurane or propofol with respect to time to following commands and time to discharge.