University of Iowa, USA.
University of Iowa, USA.
J Clin Anesth. 2023 Nov;90:111210. doi: 10.1016/j.jclinane.2023.111210. Epub 2023 Jul 21.
The objective of this systematic review was to estimate the relative risk of prolonged times to tracheal extubation with desflurane versus sevoflurane or isoflurane. Prolonged times are defined as ≥15 min from end of surgery (or anesthetic discontinuation) to extubation in the operating room. They are associated with reintubations, naloxone and flumazenil administration, longer times from procedure end to operating room exit, greater differences between actual and scheduled operating room times, longer times from operating room exit to next case start, longer durations of the workday, and more operating room personnel idle while waiting for extubation. Published randomized clinical trials of humans were included. Generalized pivotal methods were used to estimate the relative risk of prolonged extubation for each study from reported means and standard deviations of extubation times. The relative risks were combined using DerSimonian-Laird random effects meta-analysis with Knapp-Hartung adjustment. From 67 papers, there were 78 two-drug comparisons, including 5167 patients. Studies were of high quality (23/78) or moderate quality (55/78), the latter due to lack of blinding of observers to group assignment and/or patient attrition because patients were extubated after operating room exit. Desflurane resulted in a 65% relative reduction in the incidence of prolonged extubation compared with sevoflurane (95% confidence interval 49% to 76%, P < .0001) and in a 78% relative reduction compared with isoflurane (58% to 89%, P = .0001). There were no significant associations between studies' relative risks and quality, industry funding, or year of publication (all six meta-regressions P ≥ .35). In conclusion, when emergence from general anesthesia with different drugs are compared with sevoflurane or isoflurane, suitable benchmarks quantifying rapidity of emergence are reductions in the incidence of prolonged extubation achieved by desflurane, approximately 65% and 78%, respectively. These estimates give realistic context for interpretation of results of future studies that compare new anesthetic agents to current anesthetics.
本系统评价的目的是估计地氟醚与七氟醚或异氟醚相比，气管拔管时间延长的相对风险。长时间定义为手术结束（或麻醉停止）至手术室拔管时间≥15 分钟。与重新插管、纳洛酮和氟马西尼给药、从手术结束到离开手术室的时间延长、实际和计划手术室时间之间的差异增大、离开手术室到下一个病例开始的时间延长、工作日时间延长以及等待拔管时更多的手术室人员闲置有关。纳入了发表的人类随机临床试验。使用广义枢轴方法，根据拔管时间的报告均值和标准差，估算每个研究中延长拔管的相对风险。使用 DerSimonian-Laird 随机效应荟萃分析和 Knapp-Hartung 调整对相对风险进行合并。从 67 篇论文中，有 78 个双药比较，包括 5167 例患者。这些研究质量较高（23/78）或中等质量（55/78），后者归因于观察者对分组分配和/或患者流失缺乏盲法，因为患者在离开手术室后进行了拔管。与七氟醚相比，地氟醚可使长时间拔管的发生率降低 65%（95%置信区间为 49%至 76%，P<0.0001），与异氟醚相比降低 78%（58%至 89%，P=0.0001）。研究的相对风险与质量、行业资助或发表年份之间没有显著关联（所有六项荟萃回归 P≥0.35）。总之，当不同药物的全麻苏醒与七氟醚或异氟醚进行比较时，地氟醚快速苏醒的适当基准是，与七氟醚或异氟醚相比，延长拔管的发生率分别降低了约 65%和 78%。这些估计值为解释未来比较新麻醉剂与现有麻醉剂的研究结果提供了现实的背景。
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