Desflurane for maintenance of anaesthesia

Mortality or survival

Mortality was not reported in any of the papers on surgical procedures in people with a BMI of at least 30 kg/m² included in the evidence review.

Perioperative complications

Aftab et al. (2019a) found no significant difference between desflurane and propofol in the incidence of postoperative complications.

In Zucco et al. (2021), there was no statistically significant difference between desflurane and sevoflurane in the incidence of postoperative respiratory complications in either the entire study population or the subgroup of people with a BMI of at least 35 kg/m².

Up to 48 hours after surgery, the study by Tanaka et al. (2017) found no statistically significant difference in the incidence of postoperative delirium between desflurane and propofol.

Resource use

No studies reporting resource use in terms of monetary costs were identified. In the study by Aftab et al. (2019a), a similar number of people in the desflurane and propofol groups were discharged the same day as surgery (no statistically significant difference).

Short-term recovery

Tanaka et al. (2017) found no statistically significant differences between desflurane and propofol in 4 measures of cognitive function assessed 48 hours after surgery.

Longer-term recovery

Longer-term recovery was not reported in the papers on procedures in people with a BMI of at least 30 kg/m² included in this evidence review.

Limitations of the evidence

The quality assessment raised some concerns over the randomised controlled trial by Tanaka et al. (2017), and the randomised controlled trial by Aftab et al. (2019a) was considered to be at high risk of bias.

The sub-study included in this evidence review (Aftab et al. 2019a) included only 92% of participants who had sleeve gastrectomy in the original randomised controlled trial by Aftab et al. (2019b). No reasons for this are reported in the paper. There was also a difference in the proportions of missing outcome data in the desflurane and propofol groups. It is unclear whether the omissions and imbalance may have affected the results of the study.

The randomised controlled trials were small, with results analysed for around 90 participants only, divided across 2 groups. Therefore, some analyses, particularly for secondary outcomes, may lack statistical power to detect differences between the groups. This means that the evidence on the relative effects of the anaesthetic agents is uncertain. In particular, Tanaka et al. (2017) note that their study may have been underpowered to detect a difference between desflurane and propofol. This means we cannot exclude the possibility that clinically important differences may be seen in larger, sufficiently powered studies. Nevertheless, point estimates did not consistently favour 1 general anaesthetic over another.

The third study was a large retrospective cohort study (Zucco et al. 2021) in 108,438 participants. Observational studies such as cohort studies are subject to bias and confounding and cannot prove that an intervention caused an outcome, only that it is associated with that outcome. Nevertheless, the quality assessment found the study to be of good quality for a non-randomised study.

Two of the studies were undertaken in the USA and 1 in Norway. Their results are probably generalisable to the UK, although all were undertaken in single centres only and ethnicity, which can affect generalisability, was not reported. The studies included adults who were assessed as having mild or severe systemic disease. The results of the studies may not be applicable to children or adults with a worse health status at higher risk of mortality.

See the full evidence review for more information.

Evidence review commissioned by NHS England.

ISBN: 978-1-4731-5739-2