Faculty Bibliography

BACKGROUND: We recently determined how to use anesthesia information management system data to model the time from end of surgery to extubation. We applied that knowledge for meta-analyses of trials comparing extubation times after maintenance with desflurane and sevoflurane. In this study, we repeated the meta-analyses to compare isoflurane with desflurane and sevoflurane. METHODS: A Medline search through December 2009 was used to identify studies with (1) humans randomly assigned to isoflurane or desflurane groups without other differences (e.g., induction drugs) between groups, and (2) mean and SD reported for extubation time and/or time to follow commands. The search was repeated for random assignment to isoflurane or sevoflurane groups. We considered extubation times >15 minutes (representing 15% of cases in the anesthesia information management system data) to be prolonged. RESULTS: Desflurane reduced the mean extubation time by 34% and reduced the variability in extubation time by 36% relative to isoflurane. These reductions would reduce the incidence of prolonged extubation times by 95% and 97%, respectively. Sevoflurane reduced the mean extubation time by 13% and reduced the SD by 8.7% relative to isoflurane. These reductions would reduce the incidence of prolonged extubation times by 51% and 35%, respectively. CONCLUSIONS: The pharmacoeconomics of volatile anesthetics are highly sensitive to measurement of relatively small time differences. Therefore, surgical facilities should use these values combined with their local data (e.g., mean baseline extubation times) when making evidence-based management decisions regarding pharmaceutical purchases and usage guidelines.