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Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Undergoing Bariatric Surgery—a Meta-Analysis of Randomized Controlled Trials

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Abstract

Early and clear recovery from anesthesia is the crux for preventing perioperative complications in the obese undergoing bariatric surgery. Volatile inhalation agents by virtue of high lipid solubility are expected to produce residual anesthetic effects. Prospective randomized trials comparing desflurane and sevoflurane used for anesthesia maintenance (electroencephalograph guided) during bariatric surgery published till 1st of July 2017 were searched in the medical database. Comparisons were made for surrogate markers of recovery from anesthesia that included time to eye-opening (TEo), time to tracheal-extubation (TEx), and Aldrete scores on immediately shifting to recovery (Ald-I). Five trials were included in the final analysis. Patients receiving desflurane began to respond faster by opening eyes on command (five trials) by 3.80 min (95%CI being 1.83–5.76) (random effects, P < 0.01, I2 = 78.61%), and tracheal extubation was also performed earlier (four trials) by 4.97 min (95%CI being 1.34–8.59). This meant a reduction of 37% in TEo and 33.60% in TEx over sevoflurane. Ald-I scores were higher/better with desflurane by 0.52 (95%CI being 0.19–0.84) (Fixed-effects, P < 0.01, I2 = 6.67%). Publication bias is likely for TEo (Egger’s Test, X-intercept = − 8.57, P = 0.02). No airway-related complications were reported with desflurane’s expedited recovery. Use of desflurane compared to sevoflurane for maintenance of anesthesia in morbidly obese patients allows attaining verbal contact faster, and tracheal extubating can be performed earlier without compromising safety. The benefits of better recovery extend into the immediate postoperative phase with patients being more awake upon shifting to the recovery.

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Authors and Affiliations

  1. Department of Anesthesia, All India Institute of Medical Sciences, New Delhi, 110029, India

    Preet Mohinder Singh, Anuradha Borle & Anjan Trikha

  2. Anesthesiology and Perioperative, Medicine, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, PA, 19140, USA

    Jason McGavin & Ashish Sinha

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  1. Preet Mohinder Singh
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  2. Anuradha Borle
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Correspondence to Preet Mohinder Singh.

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ESM 1

Aldrete Scoring used in the studies to quantify recovery parameters. (DOCX 13 kb)

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Singh, P.M., Borle, A., McGavin, J. et al. Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Undergoing Bariatric Surgery—a Meta-Analysis of Randomized Controlled Trials. OBES SURG 27, 3031–3039 (2017). https://doi.org/10.1007/s11695-017-2929-6

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