• Gildasio S de Oliveira, Walter Girao, Paul C Fitzgerald, and Robert J McCarthy.
• Department of Anesthesiology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA. Electronic address: G-jr@northwestern.edu.
• J Clin Anesth. 2013 Sep 1;25(6):452-8.

Study ObjectiveTo compare the incidence of upper airway morbidity with sevoflurane versus desflurane in patients undergoing general anesthesia with a Laryngeal Mask Airway (LMA).DesignSystematic review and meta-analysis of randomized controlled trials (RCTs).SettingOperating room of an academic medical center.MeasurementsA 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 ResultsData 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.ConclusionsThere 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.© 2013 Elsevier Inc. All rights reserved.

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