Sevoflurane vs. Desflurane in Ambulatory Surgery 

Sevoflurane and desflurane are often used in ambulatory surgery because their pharmacokinetic properties allow for shorter anesthesia times, fast postoperative mobilization of the patient, and fewer and milder side effects¹. Despite clinicians’ best efforts, however, adverse events do occur. Respiratory problems, which can be related to anesthesia, are particularly serious¹. Because sevoflurane and desflurane are both commonly used, it is important for clinicians to understand their relative benefits, especially in terms of minimizing respiratory complications¹.  

A meta-analysis in the European Journal of Anesthesiology aggregated data from randomized control trials looking at the differences between sevoflurane and desflurane and their relationship to adverse respiratory events and other metrics of postoperative recovery¹. The operational definition of “respiratory events” in this study included everything from initial induction to extubation, so as to increase the clinical relevance of the data and put an emphasis on the role of anesthesia in suboptimal outcomes¹. The two outcomes most heavily affected by choice of anesthesia were respiratory events and time to eye opening; other events such as post-operative nausea and vomiting and emergence agitation were the same between the two groups and were affected by outside factors not considered in this study, such as using volatile anesthetics or a preoperative antiemetic prophylaxis^1,2. 

This study found an increased incidence of coughing and laryngospasm in the desflurane group, as well as decreased time to eye opening¹. Desflurane’s decreased time to eye opening has been documented in earlier studies, and while statistically significant, the difference between desflurane and sevoflurane was typically no more than five minutes and thus not clinically significant¹. There also was a higher incidence of airway events when desflurane was used for the adult and LMA groups, while there was no difference in the pediatric and endotracheal tube groups, which the article attributes to a lack of data for these patient groups¹. Lastly, despite such differences between desflurane and sevoflurane, there was no statistically significant difference between the two groups for time to discharge from the PACU¹.  

Desflurane was also previously thought to be contraindicated in pediatric surgery due to its pungent smell and irritant properties that could potentially cause adverse airway events under general anesthesia, especially when used with muscle relaxants³. A 2017 prospective randomized study published in the Journal of Anaesthesiology and Clinical Pharmacology looked at the difference between sevoflurane and desflurane and their recovery profiles in pediatric abdominal ambulatory surgery³. This study found that neither agent was associated with major respiratory or hemodynamic adverse events, and that desflurane was associated with faster emergence and faster recovery³. They also found a higher incidence of coughing associated with use of desflurane. This number was not statistically significant but was noted to be considered in procedures where coughing could affect surgical outcome³. Overall, both agents were found to be effective and safe to use in children³.  

While there are some overall differences between the two anesthetic agents in terms of respiratory complications, the choice of which to use will also depend on clinician judgment and case-by-case evaluations.  

References  

1. Chen WS, Chiang MH, Hung KC, Lin, KL, Wang, CH, Poon YY, Luo SD, Wu SC. Adverse respiratory events with sevoflurane compared with desflurane in ambulatory surgery. European Journal of Anaesthesiology 2020; 37(12): 1093-1104. doi: 10.1097/EJA.0000000000001375 

2. Green G, Jonsson L. Nausea: the most important factor determining length of stay after ambulatory anaesthesia. A comparative study of isoflurane and/or propofol techniques. Acta Anaesthesiologica Scandinavia 1993; 37:742–746. doi: 10.1111/j.1399-6576.1993.tb03801.x. 

3. Kotwani MB, Malde AD. Comparison of maintenance, emergence and recovery characteristics of sevoflurane and desflurane in pediatric ambulatory surgery. Journal of Anaesthesiology and Clinical Pharmacology 2017; 33(4): 503-508. doi: 10.4103/joacp.JOACP_194_16