Goals for ambulatory surgery include providing optimal surgical conditions while ensuring a rapid early recovery without side effect. Dexter et al1 concluded in a meta-analysis that Desflurane can reduce the extubation time when compared to Sevoflurane. This potential benefit of Desflurane can be especially attractive in short ambulatory cases performed with general anesthesia with a laryngeal mask airway.

Although some studies have not shown a difference on perioperative cough and laryngospasm between Desflurane and Sevoflurane at clinically relevant doses.It has been reported in the literature that Desflurane causes cough4 and many providers avoid using Desflurane with a LMA (laryngeal mask airway) in the ambulatory setting. In this study we will also evaluate, as a secondary outcome, the presence and severity of perioperative cough and laryngospasm.

Previous investigators have demonstrated a more rapid resumption of normal daily activities after ambulatory surgery in patients anesthetized with Desflurane when compared with Sevoflurane.these investigators suggested a better quality of recovery when Desflurane is used probably due to a lower lipid solubility of Desflurane. We will also evaluate quality of recovery as a secondary outcome using a validated instrument.

Significance:

1. A more rapid awakening, especially, in a fast and high turnover cases that are performed with LMA can lead to a more cost effective utilization of operating room time
2. It has been reported that Desflurane causes more cough than Sevoflurane and Anesthesiologists avoid using Desflurane with LMA cases, this study will reinforce that there is no difference.

Inclusion Criteria:

• Age 18-65
• Female patients undergoing outpatient gynecologic and breast surgery
• Under general anesthesia using an LMA
• ASA I,II,

Exclusion Criteria:

• Patients on CNS depressants
• Chronic opioid use
• Corticosteroid
• Pregnant patients
• Full stomach
• Morbidly obese (BMI >35kg/m2)
• Hepatitis B
• Hepatitis C
• Coronary artery disease
• Liver disease
• Renal disease
• Seizure disorder

Dropout criteria:

• Need for endotracheal tube
• Surgeon or patient request
• Hospital admission

Intraoperative period from induction of anesthesia until time of discharge from the operating room.

Laryngospasm occuring from the introduction of inhalation agent to time of discharge from the operating room

Our study is only valid if interpreted within the context of its limitations. We have only evaluated female subjects undergoing ambulatory hysteroscopic surgery which limits the generalizability of our results.