Desflurane vs. Sevoflurane: Ambulatory surgery

Sevoflurane and desflurane are volatile anesthetics that are both halogenated ethers. They both have relatively low blood:gas solubility coefficients (0.65 for sevoflurane and 0.42 for desflurane) allowing for quick emergence from anesthesia. Nathanson et al and Jindal et al studied the use of sevoflurane versus desflurane during outpatient surgery in laparoscopic gynecologic surgery. Nathanson examined the time to emergence, time to extubation, time for recovery from anesthesia, postoperative VAS (visual analog scale) scores, and side effects between the two agents. Desflurane led to faster time to emergence and time to extubation; however, recovery time, postoperative VAS scores, and side effects were similar. Similarly, Jindal et al examined recovery time as well as readiness for home discharge. While desflurane led to decreased recovery time from anesthesia, there was no difference in time to home discharge. One downside to desflurane is it may result in airway irritability, causing coughing, hiccuping, breath holding, or laryngospasm. Dalal et al compared desflurane with sevoflurane use in spontaneously ventilating patients with laryngeal mask airways in place during gynecologic procedures, and although they noted 13.3% adverse airway events in the desflurane group compared to the 6.6% in the sevoflurane group, this difference was not statistically significant. In summary, it appears that both desflurane and sevoflurane are reasonable choices for inhalational anesthesia in the outpatient setting as time to discharge is similar with the use of either agent.