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PubMed · 2071218

Recovery from general anesthesia.

D Curtis·W C Stevens
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Abstract

The pattern of recovery from anesthesia is ordinarily quite predictable. Using a limited number of drugs to provide anesthesia further improves predictability; it is more difficult to assign a cause for delayed emergence when multiple agents have been administered. We believe the recovery period is often more difficult to manage safely than induction and maintenance of anesthesia. During this phase, the effects of surgical trauma are superimposed on the patient's preexisting disease state, the anesthetic level is changing rapidly, respiratory function has not returned to normal, and circulatory reflexes may not have been regained. Because the patient is being moved from the operating room and care of the patient is being transferred from one person or team to others, vigilance and treatment may also be impaired. It is a period of care that warrants further study.

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Anesthesia Recovery PeriodAnesthesia, InhalationAnestheticsHumansJournal ArticleReview

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D Curtis, W C Stevens. 1991. Recovery from general anesthesia.. https://doi.org/10.1097/00004311-199121000-00003

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PubMed2006

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BACKGROUND AND OBJECTIVE: To evaluate the effects of sevoflurane and desflurane in combination with intravenous remifentanil on time for discharge from the postanaesthesia care unit and need for postanaesthesia care unit management after elective laparoscopic cholecystectomy. METHODS: 231 ASA Grade I-II patients, undergoing elective laparoscopic cholecystectomy in seven University teaching hospital, were randomly allocated to receive a desflurane-remifentanil (n = 105) or sevoflurane-remifentanil (n = 126) anaesthetic. A blinded observer recorded times for emergence and postanaesthesia care unit discharge (achievement of an Aldrete score > or =9), number of patients eligible for postanaesthesia care unit discharge when exiting the operating room and occurrence of adverse events. RESULTS: Intraoperative cardiovascular stability was similar in the two groups. Emergence, response and extubation occurred earlier after desflurane (5.4 +/- 3 min, 5.5 +/- 3 min and 7.5 +/- 4 min) than sevoflurane (6.6 +/- 3.5 min, 7.2 +/- 4 min and 9.1 +/- 4.2 min) (P = 0.0005, 0.05 and 0.003, respectively). Postanaesthesia care unit bypass was possible in 44 desflurane-remifentanil patients (41%) and 55 sevoflurane- remifenatnil patients (43%) (P = 0.69), while postanaesthesia care unit discharge occurred after 46 min (25th-75th percentiles: 18-40 min) with desflurane and 64 min (25th-75th percentiles: 20-50 min) with sevoflurane (P = 0.04). Postoperative nausea and vomiting was observed in 40 desflurane-remifentanil patients (36%) and 53 sevoflurane-remifentanil patients (42%) (P = 0.42). CONCLUSIONS: Both the desflurane-remifentanil and sevoflurane-remifentanil combinations provide a similarly adequate intraoperative cardiovascular stability. Emergence and postanaesthesia care unit discharge were faster with desflurane-remifentanil than sevoflurane-remifentanil, but this was not associated with a larger proportion of postanaesthesia care unit bypass, confirming that no clinically relevant differences are present between the two agents.

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