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Desflurane is not associated with faster operating room exit times in outpatients
N Patel1, C E Smith, A C Pinchak
1Department of Anesthesiology, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
Study Objective:
To determine the influence of anesthetic technique and primary drug on operating room (OR) exit time (time between end of surgery until time patient exists the OR) after addition of desflurane to the hospital formulary.
Design:
Prospective study.
Setting:
Ambulatory surgery unit of a university hospital.
Patients:
1,568 outpatients requiring anesthesia.
Interventions:
Addition of desflurane to the hospital formulary, and substitution of desflurane vaporizers for enflurane vaporizers in the ambulatory surgery unit.
Measurements And Main Results:
The following information was recorded for all anesthetic encounters over a six-month time interval: demographics, duration of surgery, primary anesthetic technique, primary anesthetic drug, and exit times. General anesthesia was used in 907 patients [desflurane: 209 patients, isoflurane: 429 patients, halothane: 192 patients, propofol: 72 patients, other intravenous (i.v.): 5 patients], major conduction anesthesia (spinal and epidural) in 43 patients, peripheral nerve blocks in 90 patients, and i.v. sedation in 528 patients. The exit time was significantly greater ( < 0.05) in patients who received general anesthesia (mean +/- SEM 14 +/- 0.2 min) compared with spinal/epidural (8 +/- 0.7 min), nerve blocks (8 +/- 0.4 min) and i.v. sedation (7 +/- 0.2 min). Exit times were longer in older patients receiving general anesthesia (exit time = 12.3 + 0.04 x age, SE = 6.7 min, p < 0.0009), whereas exit times were shorter in older individuals receiving i.v. sedation (exit time = 8.97 - 0.038 x age, SE = 3.6 min, p < 0.0001). For patients receiving i.v. sedation, exit times were shorter as duration of surgery increased (exit time = 7.86 - 0.015 x duration of surgery, SE = 3.6 min, p < 0.0002). Primary anesthetic drug did not affect exit times.
Conclusion:
Regional anesthesia and i.v. sedation were associated with faster OR exit times compared with general anesthesia. Despite desflurane's shorter elimination kinetics and recovery characteristics, use of this drug did not result in shorter exit times.