The effect of sevoflurane versus desflurane on the incidence of upper respiratory morbidity in patients undergoing general anesthesia with a Laryngeal Mask Airway: A meta-analysis of randomized controlled trials

Gildasio S. De Oliveira*, Walter Girao, Paul C. Fitzgerald, Robert J. McCarthy

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

Abstract

Study Objective To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA). Design Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting Operating room of an academic medical center. Measurements A systematic review of RCTs of patients receiving general anesthesia with a LMA was performed. Sevoflurane and desflurane were used for maintenance of anesthesia in the RCTs. A wide search was performed to identify RCTs comparing desflurane with sevoflurane on the incidence of upper respiratory adverse events in patients undergoing surgery with a LMA. The primary outcomes were incidence of cough and laryngospasm. A random-effects model was used to perform quantitative analysis. Main Results Data originating from 7 studies comprising 657 subjects were analyzed. The confidence interval (CI) was large relative to a clinically significant difference in the incidence of overall cough and laryngospasm in patients receiving desflurane versus sevoflurane (odds ratio [OR; 95% CI] of 1.44 [0.49 - 4.1] and 3.06 [0.43 - 21.62]), respectively. The incidence of cough at emergence was greater in subjects receiving desflurane compared with sevoflurane (OR [95% CI] of 2.43 [1.2 - 4.7], number needed to harm [NNH] = 9.0); however, the analysis was limited by the presence of an asymmetric funnel plot suggesting the possibility of publication bias. Conclusions There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.

Original languageEnglish (US)
Pages (from-to)452-458
Number of pages7
JournalJournal of Clinical Anesthesia
Volume25
Issue number6
DOIs
StatePublished - Sep 2013

Keywords

  • Airway management
  • Anesthesia emergence
  • Coughing, intraoperative
  • Laryngeal Mask Airway
  • Laryngospasm
  • Upper airway adverse events

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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