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July 1, 2001Anesthesia & Analgesia

Fast-Tracking After Outpatient Laparoscopy: Reasons for Failure After Propofol, Sevoflurane, and Desflurane Anesthesia

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Why the study?

Does maintenance anesthesia with sevoflurane or desflurane compared to propofol improve fast-track eligibility and PACU bypass rates in healthy female outpatients undergoing laparoscopic tubal ligation?

Population

51 healthy female outpatients scheduled for laparoscopic tubal ligation procedures. Excluded: serious…

Comparison

Maintenance anesthesia with sevoflurane 1.2% or… vs Maintenance anesthesia with propofol infusion…

Design

RCT, Randomly assigned to one of three anesthetic treatment groups on the…

Follow-up

72 to 96 hours

Authors

MCMargarita ColomaFundación Juan MarchTZTianjun ZhouThe University of Texas Southwestern Medical CenterPWPaul F. WhiteCedars-Sinai Medical Center

Discussion

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Implication

Volatile anesthetics raise fast-track eligibility without increasing PACU bypass; challenges assumption that anesthetic choice alone drives fast-tracking success.

Structured PICO

Does maintenance anesthesia with sevoflurane or desflurane compared to propofol improve fast-track eligibility and PACU bypass rates in healthy female outpatients undergoing laparoscopic tubal ligation?

P
Population
51 healthy female outpatients scheduled for laparoscopic tubal ligation procedures. Excluded: serious preexisting medical condition, body weight >50% above ideal, history of alcohol or drug abuse.
I
Intervention
Maintenance anesthesia with sevoflurane 1.2% or desflurane 3% in combination with N2O 65% in oxygen, titrated to a target BIS value of 60.
C
Comparator
Maintenance anesthesia with propofol infusion 100 μg·kg−1·min−1 in combination with N2O 65% in oxygen, titrated to a target BIS value of 60.
O
Outcome
Time to achieve fast-track eligibility and actual rate of bypassing the postanesthesia care unit (PACU).

While volatile anesthetics like sevoflurane and desflurane improve fast-track eligibility compared to propofol, actual PACU bypass rates are often limited by nonanesthetic factors and clinician hesitation.

Limitations

  • Underpowered with respect to later recovery end points
  • Use of an investigational muscle relaxant (rapacuronium) may have confounded the anesthesiologist's decision to bypass the PACU

Cite This Study

Coloma et al. (2001) studied this question.

synapsesocial.com/papers/6a86edbf9749833e6e15495ahttps://doi.org/10.1097/00000539-200107000-00024
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1New Criteria for Fast-Tracking After Outpatient Anesthesia1999 · 254 citations
  2. 2Effects of propofol vs isoflurane on respiratory gas exchange during laparoscopic cholecystectomy1998 · 18 citations
  3. 3Development and Psychometric Testing of a Quality of Recovery Score After General Anesthesia and Surgery in Adults1999 · 430 citations
  4. 4Comparison of the Costs and Recovery Profiles of Three Anesthetic Techniques for Ambulatory Anorectal Surgery2000 · 188 citations
  5. 5Pulmonary Edema After Absorbing Crystalloid Irrigating Fluid During Laparoscopy1994 · 11 citations