Desflurane Versus Isoflurane for Speeding Postanesthetic Recovery and Hospital Discharge

Desflurane Versus Isoflurane for Speeding Postanesthetic Recovery and Hospital Discharge: a Cluster Randomized Crossover Trial

The investigators thus propose a comparative effectiveness quality improvement project to evaluate the feasibility of switching from near-exclusive use of isoflurane in adult general surgical patients to Desflurane.

The three available volatile anesthetics appear to be comparably safe. However, higher solubility slows emergence from isoflurane and sevoflurane compared to Desflurane. Even a few minutes delay in emergence from anesthesia has financial implications since institutional costs of operating room time can easily be $30 per minute. Postoperative care is also expensive. Furthermore, in busy hospitals such as the Cleveland Clinic, inadequate recovery throughput frequently delays surgery.

The investigators thus propose a comparative effectiveness quality improvement project to evaluate the feasibility of switching from near-exclusive use of isoflurane in adult general surgical patients to Desflurane. (The investigators will exclude children because there are compelling clinical reasons to use sevoflurane in pediatric patients.) The proposed comparison is between isoflurane (our current routine) and Desflurane which is no longer used at the Clinic because of price concerns - a decision that that did not consider down-stream effects, including prolonged emergence and recovery.

Inclusion Criteria:

• Adults having general anesthesia in the G operating room suite at the Cleveland Clinic Main Campus.

Exclusion Criteria:

• Operations lasting <1.5 hours.