Desflurane is not inferior to sevoflurane in the occurrence of adverse respiratory events during laryngeal mask airway anesthesia: a non-inferiority randomized double-blinded controlled study

Background Compared to sevoflurane, desflurane is less favorable to most anesthesiologists for laryngeal mask airway (LMA) anesthesia because desflurane has a pungent odor. This non-inferiority study aimed to determine whether desflurane is not worse than sevoflurane in triggering airway irritations during general anesthesia using LMA. Methods Patients scheduled for elective surgery under LMA anesthesia were randomly allocated to receive either desflurane or sevoflurane for maintenance of anesthesia. After intravenous fentanyl, lidocaine and propofol administration followed by LMA insertion, 0.5-1.0 MAC of the volatile anesthetic in 50% N2O was maintained throughout the surgery. The primary outcome was the occurrence of perioperative adverse respiratory events. Other outcomes included recovery profiles, hemodynamic changes and postoperative complications. Results One-hundred and ten patients per group completed the study without any serious complications, lost to follow-up, or protocol deviation. During awake LMA removal, patients in the desflurane group experienced lesser episodes of laryngospasm (risk difference, -7.3%; 95% CI, -12.7% to -1.9%; P=0.009) than those in the sevoflurane group. The emergence time and time to LMA removal were significantly shorter in the desflurane group. The quality of recovery indicated by an ability to self-transfer from bed to bed was significantly better after desflurane anesthesia. No difference between groups was found in a return of orientation and a readiness for post-anesthesia care unit discharge. Conclusions Desflurane is non-inferior to sevoflurane in the occurrence of laryngospasm at emergence after LMA anesthesia. The superiority of desflurane compared to sevoflurane with regards to respiratory complications requires further investigation.