Advice
Key messages
Neurological procedures
No evidence was identified to suggest that using desflurane instead of other general anaesthetic agents for maintenance of anaesthesia is associated with improved clinical or cost outcomes in people undergoing neurological procedures. Overall, results of the studies included in the evidence review did not favour 1 general anaesthetic over another.
Overall, 5 randomised controlled trials found no statistically significant differences between desflurane and other general anaesthetic agents for all but 1 of the outcome measures relevant to the population, intervention, comparator and outcomes (PICO) framework, which are core outcome measures for perioperative and anaesthetic care. The only statistically significant difference was in mean cognitive impairment scores (using the Montreal Cognitive Assessment Scale) at discharge or 2 weeks after surgery in 1 study. Mean scores were statistically significantly worse in the desflurane group than in the propofol group (p=0.013). However, the quality assessment raised concerns about this study, which failed to recruit sufficient participants and probably lacked statistical power to detect any true differences between the treatment groups.
The quality assessment also raised some concerns about 2 other studies, and analyses of secondary outcomes in all 4 of the other studies may lack statistical power to detect differences between the groups. This means the evidence is uncertain and we cannot exclude the possibility that clinically important differences may be seen in larger, sufficiently powered studies. The evidence is available for a limited number of neurological procedures only, which may limit their applicability more widely (such as in extremely long duration surgeries).
BMI at least 30 kg/m2 having any procedure
No evidence was identified to suggest that using desflurane instead of other general anaesthetic agents for maintenance of anaesthesia is associated with improved clinical or cost outcomes in people with a BMI of at least 30 kg/m2 having any procedure. Overall, results of the studies included in the evidence review did not favour 1 general anaesthetic over another.
Overall, 2 randomised controlled trials and 1 large retrospective cohort study found no statistically significant differences between desflurane and other general anaesthetic agents for outcome measures relevant to the PICO. The quality assessment raised some concerns about 1 randomised controlled trial, which lacked statistical power for all outcomes, and the other was considered to be at high risk of bias. The cohort study was assessed as being good quality but is an observational study with many inherent limitations. In all studies, secondary outcomes may lack statistical power to detect differences between the groups meaning the evidence is uncertain and we cannot exclude the possibility that clinically important differences may be seen in larger, sufficiently powered studies.