Desflurane versus propofol for ambulatory surgery: A systematic review and meta-analysis

This study aimed to evaluate the efficacy, side effects and recovery profile of two commonly used anesthetic agents, desflurane versus propofol, for maintaining general anesthesia in ambulatory surgery.

Studies compared propofol with desflurane in adult patients undergoing ambulatory surgery were included. The generalized pivotal method was used to estimate the median and variance of the ratios of means and standard deviations of recovery times, and these ratios were then pooled in a DerSimonian-Laird random-effects meta-analysis with Knapp-Hartung adjustment.

Twenty-two studies with a total of 1504 adult participants were included in this review. Compared with propofol, desflurane significantly reduced early recovery times, with reductions of at least 9.1% in mean time and 4.2% in standard deviation (variability) (both based on the lower limit of the 99%CI), all significant after Benjamini-Hochberg (BH) correction. In contrast, no significant differences were observed for most intermediate and late recovery metrics. Desflurane increased the risk of in-hospital PONV (RR: 2.15, 95%CI: 1.12 to 4.11), and postoperative antiemetic rescue (RR: 2.59, 95%CI: 1.35 to 4.95), all significant after BH correction. The subgroup analysis indicated that adding N₂O to desflurane was associated with an increased incidence of in-hospital PONV compared with propofol plus N₂O.

In ambulatory surgery, desflurane demonstrated faster early recovery, higher incidence of in-hospital PONV and antiemetic rescue, compared with propofol. The reductions in mean time and variability for early recovery with desflurane could potentially contribute to improved operating room efficiency and lower labor costs. Future studies are needed to confirm these findings.