PMID- 37713329
OWN - NLM
STAT- Publisher
LR  - 20231020
IS  - 1526-7598 (Electronic)
IS  - 0003-2999 (Linking)
VI  - 137
IP  - 5
DP  - 2023 Nov 1
TI  - Postanesthesia Care Unit Recovery Time According to Volatile Anesthetic Used in 
      Clinical Practice.
PG  - 1066-1074
LID - 10.1213/ANE.0000000000006647 [doi]
AB  - BACKGROUND: Whether volatile anesthetic solubility affects postanesthesia 
      recovery time in clinical practice is unclear. We investigated the association 
      among 3 volatile agents and 2 clinically relevant outcomes-postanesthesia care 
      unit (PACU) recovery time (time from PACU admission to fulfillment of discharge 
      criteria) and oversedation (Richmond Agitation-Sedation Scale score </=-3)-as a 
      potential contributor to delaying PACU discharge. The volatile agents studied 
      were isoflurane, desflurane, and sevoflurane. We hypothesized that increased 
      solubility of the volatile agent (isoflurane versus desflurane or sevoflurane) 
      would be associated with longer PACU recovery time and higher rates of 
      oversedation. METHODS: This retrospective observational study included adults 
      (>/=18 years) who underwent surgical procedures under general anesthesia with a 
      volatile agent and were admitted to the PACU from May 5, 2018, to December 31, 
      2020. The primary outcome was PACU recovery time, and the secondary outcome was 
      oversedation. PACU recovery time was log-transformed and analyzed with linear 
      regression. Oversedation was analyzed by using logistic regression. To account 
      for potential confounding, inverse probability of treatment weighting (IPTW) was 
      used. Pairwise comparisons of the 3 agents were performed, with P < .017 
      (Bonferroni-adjusted) considered significant. RESULTS: Of 47,847 patients 
      included, 11,817 (24.7%) received isoflurane, 11,286 (23.6%) received desflurane, 
      and 24,744 (51.7%) received sevoflurane. Sevoflurane had an estimated 4% shorter 
      PACU recovery time (IPTW-adjusted median [interquartile range IQR], 61 [42-89] 
      minutes) than isoflurane (64 [44-92] minutes) (ratio of geometric means [98.3% 
      confidence interval CI], 0.96 [0.95-0.98]; P < .001). Differences in PACU 
      recovery time between desflurane and the other agents were not significant. The 
      IPTW-adjusted frequency of oversedation was 8.8% for desflurane, 12.2% for 
      sevoflurane, and 16.7% for isoflurane; all pairwise comparisons were observed to 
      be significant (odds ratio [98.3% CI], 0.70 [0.62-0.79] for desflurane versus 
      sevoflurane, 0.48 [0.42-0.55] for desflurane vs isoflurane, and 0.69 [0.63-0.76] 
      for sevoflurane versus isoflurane; all P < .001). Although oversedated patients 
      had longer PACU recovery time, differences in the oversedation rate across agents 
      did not result in meaningful differences in time to PACU recovery. CONCLUSIONS: 
      In clinical practice, only small, clinically unimportant differences in PACU 
      recovery time were observed between the volatile anesthetics. Although 
      oversedation was associated with increased PACU recovery time, differences in the 
      rate of oversedation among agents were insufficient to produce meaningful 
      differences in overall PACU recovery time across the 3 volatile agents. Practical 
      attempts to decrease PACU recovery time should address factors other than 
      volatile agent selection.
CI  - Copyright (c) 2023 International Anesthesia Research Society.
FAU - Sprung, Juraj
AU  - Sprung J
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Deljou, Atousa
AU  - Deljou A
AD  - From the Department of Anesthesiology and Perioperative Medicine.
FAU - Warner, David O
AU  - Warner DO
AD  - Emeritus Member, Department of Anesthesiology and Perioperative Medicine.
FAU - Schroeder, Darrell R
AU  - Schroeder DR
AD  - Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota.
FAU - Weingarten, Toby N
AU  - Weingarten TN
AD  - From the Department of Anesthesiology and Perioperative Medicine.
LA  - eng
PT  - Journal Article
DEP - 20230915
PL  - United States
TA  - Anesth Analg
JT  - Anesthesia and analgesia
JID - 1310650
SB  - IM
COIS- Conflicts of Interest: See Disclosures at the end of the article.
EDAT- 2023/09/15 18:42
MHDA- 2023/09/15 18:42
CRDT- 2023/09/15 13:13
PHST- 2023/09/15 18:42 [pubmed]
PHST- 2023/09/15 18:42 [medline]
PHST- 2023/09/15 13:13 [entrez]
AID - 00000539-990000000-00625 [pii]
AID - 10.1213/ANE.0000000000006647 [doi]
PST - ppublish
SO  - Anesth Analg. 2023 Nov 1;137(5):1066-1074. doi: 10.1213/ANE.0000000000006647. 
      Epub 2023 Sep 15.