Meta-analysis of desflurane and propofol average times and variability in times to extubation and following commands

Wachtel, Ruth E.; Dexter, Franklin; Epstein, Richard H.; Ledolter, Johannes

doi:10.1007/s12630-011-9519-1

Cited by 77 publications

(47 citation statements)

References 53 publications

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“…5 Extubation times differ significantly among anesthetic drugs. 4,15,20 Propofol has become popular for general anesthesia, especially in the ambulatory setting. It is frequently used in combination with remifentanil since both drugs have been reported to enable rapid emergence from anesthesia and early return to normal activities.…”

Section: Discussionmentioning

confidence: 99%

“…13 The interval between the end of surgery and extubation is of particular interest to surgeons and anesthesia care providers because it is affected by anesthetic agents. 1,4,19,20 Anesthesiologists associate prolonged tracheal extubation time with poor recovery from anesthesia.…”

mentioning

confidence: 99%

“…Recently, a meta-analysis comparing operating room recovery times for desflurane (DES) and propofol reported that, relative to propofol, DES proportionally reduced the mean time to extubation and time to follow commands (21% and 23%, respectively). 20 However, only 2 studies 9,14 of prolonged anesthesia or surgery duration were included in this meta-analysis. In our previous prospective study, patients undergoing lengthy procedures were found to recover more quickly after total intravenous anesthesia (TIVA) via a target-controlled infusion (TCI) system, than with volatile anesthesia.…”

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confidence: 99%

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Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Lin

Lee³

et al. 2016

SPI

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OBJECT Anesthesia techniques can contribute to the reduction of anesthesia-controlled time and may therefore improve operating room efficiency. However, little is known about the difference in anesthesia-controlled time between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia techniques for prolonged lumbar spine surgery under general anesthesia. METHODS A retrospective analysis was conducted using hospital databases to compare the anesthesia-controlled time of lengthy (surgical time > 180 minutes) lumbar spine surgery in patients receiving either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia, between January 2009 and December 2011. A variety of time intervals (surgical time, anesthesia time, extubation time, time in the operating room, postanesthesia care unit [PACU] length of stay, and total surgical suite time) comprising perioperative hemodynamic variables were compared between the 2 anesthesia techniques. RESULTS Data from 581 patients were included in the analysis; 307 patients received TIVA and 274 received DES anesthesia. The extubation time was faster (12.4 ± 5.3 vs 7.0 ± 4.5 minutes, p < 0.001), and the time in operating room and total surgical suite time was shorter in the TIVA group than in the DES group (326.5 ± 57.2 vs 338.4 ± 69.4 minutes, p = 0.025; and 402.6 ± 60.2 vs 414.4 ± 71.7 minutes, p = 0.033, respectively). However, there was no statistically significant difference in PACU length of stay between the groups. Heart rate and mean arterial blood pressure were more stable during extubation in the TIVA group than in the DES group. CONCLUSIONS Utilization of TIVA reduced the mean time to extubation and total surgical suite time by 5.4 minutes and 11.8 minutes, respectively, and produced more stable hemodynamics during extubation compared with the use of DES anesthesia in lengthy lumbar spine surgery.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Lin

Lee³

et al. 2016

SPI

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“…Our results are important because tracheal extubation times differ significantly among anesthetic drugs (e.g., from metaanalysis of randomized trials, C 95% reduction in the incidence of prolonged tracheal extubation times with desflurane vs isoflurane). 8,20,21 Nevertheless, our results are limited in being heterogeneous among hospitals (i.e., they are screening criteria to be used by facilities to choose whether or not to perform a full facility-specific analysis). 2,4,19 We focused on prolonged tracheal extubation times because their incidence is increased by large mean tracheal extubation times, large standard deviation of tracheal extubation times, or both.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] The full cost analysis can be performed using data from randomized trials and the hospital's OR information system. 3,4,8,[19][20][21] Suppose that essentially all (e.g., [ 90%) ORs at a hospital have more than 8 hours of cases each workday. Then, OR time is a variable cost.…”

Section: Résumémentioning

confidence: 99%

Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Epstein

Dexter

Brull

2013

Can J Anesth/J Can Anesth

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Purpose The economics of the use of an anesthetic drug or device that produces benefit through reduction in operating room (OR) time depends on the day of the week and the total hours of surgical cases in the OR in which they are performed. Principally, this has to do with different durations of the regularly scheduled workday in the ORs within and among hospitals. We tested hypotheses relevant to the economic benefit of avoiding prolonged tracheal extubation times. Methods Observational data were obtained from a multiple-specialty academic tertiary hospital that uses an anesthesia information management system. Prolonged tracheal extubation times were considered those with tracheal extubations occurring 15 min or more after the end of surgery. The assessment of prolonged tracheal extubation times was limited to cases for which the patient's trachea was intubated and extubated while physically in the OR. Percentages were calculated for each of n = 39 four-week periods. Results are reported as mean (standard error of the mean) of these percentages, and the phrases ''at most/least'' are used to refer to the corresponding 95% confidence limits.Results At most, 6.1% [mean 5.5 (0.3)%] of the prolonged tracheal extubation times were attributable to cases that did not end during regular workdays from 7:00 AM-10:59 PM. At least 55.6% of prolonged tracheal extubation times occurred during cases on regular workdays and in an OR with more than eight hours of cases and turnovers [mean 57.0 (0.9)%; P \ 0.0001]. This percentage was 23.8 (0.8)% larger than for all other cases. Conclusions In the absence of an accurate facilityspecific cost analysis, prolonged tracheal extubation times should not be treated as fixed costs but as resulting in proportionally increased OR variable costs. RésuméObjectif En anesthésie, les économies résultant de l'utilisation d'un médicament ou d'un dispositif qui entraîne des avantages en réduisant le temps en salle d'opération (SO) dépendent du jour de la semaine et du nombre total d'heures de cas chirurgicaux réalisés dans cette salle. Ces économies ont surtout à voir avec les différences de durée d'une journée de travail normale planifiée dans les SO à l'intérieur de chaque hô pital et entre les hô pitaux. Nous avons testé des hypothèses pertinentes aux avantages économiques liés à la prévention d'un délai d'extubation trachéale prolongés. Méthode Nous avons obtenu des données observationnelles d'un hô pital tertiaire, universitaire et pluri-spécialisé qui se sert d'un système de gestion de l'information en anesthésie. Nous avons défini qu'il y avait

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Principles of an Ambulatory Surgery Service

Salmon¹,

Patel²

2021

Ambulatory Urology and Urogynaecology

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Meta-analysis of desflurane and propofol average times and variability in times to extubation and following commands

Cited by 77 publications

References 53 publications

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Faster extubation time with more stable hemodynamics during extubation and shorter total surgical suite time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in lengthy lumbar spine surgery

Cohort study of cases with prolonged tracheal extubation times to examine the relationship with duration of workday

Principles of an Ambulatory Surgery Service

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