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Comparisons Between Desflurane and Isoflurane or Propofol on Time to Following Commands and Time to Discharge

1996; Lippincott Williams & Wilkins; Volume: 40; Issue: 2 Linguagem: Inglês

10.1097/00132586-199604000-00003

1536-7185

Franklin Dexter, John H. Tinker,

Cardiac, Anesthesia and Surgical Outcomes

Comment By pooling data, meta-analysis generates narrow confidence intervals for the mean differences. Random effects meta-analysis applies, regardless of whether the mean differences from various studies are homogeneous. The random-effects model allows differences among observed outcomes in studies, not only because of sampling error but also because there may be very real, underlying population differences. The narrow confidence intervals generated by meta-analysis should enable clinicians to know more precisely what can be expected by administering desflurane as a maintenance agent rather than propofol or isoflurane with respect to awakening and following commands. The authors wisely point out that objective clinical and financial decision-making is not based on whether patients wake up significantly more rapidly per se. Rather, anesthesiologists can more rationally decide which drugs to administer based on magnitudes of treatment effects. Interestingly, the lower tissue/gas and tissue/blood partition coefficients of desflurane vs. isoflurane did not translate into a much more rapid recovery from anesthesia. Whether the slightly more rapid awakening with desflurane compared with isoflurane is clinically important is a matter for the individual anesthesiologist to decide. It does appear, however, that propofol may offer an advantage over desflurane with respect to rapidity of discharge home after ambulatory surgery. Again, the individual anesthesiologist must decide the clinical significance of this to his or her practice.