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  • Title: The effect of sevoflurane versus desflurane on the incidence of upper respiratory morbidity in patients undergoing general anesthesia with a Laryngeal Mask Airway: a meta-analysis of randomized controlled trials.
    Author: de Oliveira GS, Girao W, Fitzgerald PC, McCarthy RJ.
    Journal: J Clin Anesth; 2013 Sep; 25(6):452-8. PubMed ID: 23965188.
    Abstract:
    STUDY OBJECTIVE: To compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA). DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs). SETTING: Operating room of an academic medical center. MEASUREMENTS: A systematic review of RCTs of patients receiving general anesthesia with a LMA was performed. Sevoflurane and desflurane were used for maintenance of anesthesia in the RCTs. A wide search was performed to identify RCTs comparing desflurane with sevoflurane on the incidence of upper respiratory adverse events in patients undergoing surgery with a LMA. The primary outcomes were incidence of cough and laryngospasm. A random-effects model was used to perform quantitative analysis. MAIN RESULTS: Data originating from 7 studies comprising 657 subjects were analyzed. The confidence interval (CI) was large relative to a clinically significant difference in the incidence of overall cough and laryngospasm in patients receiving desflurane versus sevoflurane (odds ratio [OR; 95% CI] of 1.44 [0.49 - 4.1] and 3.06 [0.43 - 21.62]), respectively. The incidence of cough at emergence was greater in subjects receiving desflurane compared with sevoflurane (OR [95% CI] of 2.43 [1.2 - 4.7], number needed to harm [NNH] = 9.0); however, the analysis was limited by the presence of an asymmetric funnel plot suggesting the possibility of publication bias. CONCLUSIONS: There is a lack of evidence that desflurane causes a greater incidence of upper airway adverse events than sevoflurane in patients undergoing general anesthesia with a LMA.
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