Fewer patients in the TIVA group had and needed rescue therapy for PONV compared to patients in the DES group. (Image source: Thinkstock)

Fewer patients in the TIVA group had and needed rescue therapy for PONV compared to patients in the DES group. (Image source: Thinkstock)

Desflurane or propofol: which is better for wake-up time and PACU discharge? Few studies have compared wake-up times between total intravenous anesthesia (TIVA) with propofol administered using a target-controlled infusion system and desflurane in patients undergoing eye surgery. Dr. Chueng-He Lu, Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan, Republic of China, and colleagues retrospectively analyzed extubation and PACU discharge times for roughly 1400 patients who underwent eye surgery between January 2010 and December 2011. The results of their study are published in this month’s issue of Anesthesia & Analgesia and summarized in the article titled “An Analysis of Anesthesia-Controlled Operating Room Time After Propofol-Based Total Intravenous Anesthesia Compared with Desflurane Anesthesia in Ophthalmic Surgery: A Retrospective Study.”

The authors studied 1405 patients. Of these, 595 received propofol and 810 received desflurane anesthesia. All patients received dexamethasone 5 mg. Patients who received propofol were extubated sooner (1.9 min, 14%) than patients who received desflurane. Patients who received propofol spent less time in the PACU (3.6 min, 5%) than patients who received desflurane. Fewer patients receiving propofol had PONV ((11.3% versus 32.2%, risk difference 21.0%) or needed rescue PONV therapy (23.9% versus 54.0%, risk difference 30.1%).

As the authors note, their group did not use high fresh gas flows after turning off desflurane, which may have affected results. Furthermore, this was not a randomized trial. As Dr. Franklin Dexter, Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, and Dr. Ruth E. Wachtel, Department of Anesthesia, University of Iowa, Iowa City, Iowa, state in the accompanying editorial titled “Ophthalmologic Surgery is Unique in Operating Room Management,” “The brief durations of ophthalmologic surgery made it possible to perform this study, but potential mechanisms seem quite unlikely to apply to most other specialties. Yes, the management science of ophthalmologic surgery is different.”