Anaesthesia, recovery and postoperative nausea and vomiting after breast surgery. A comparison between desflurane, sevoflurane and isoflurane anaesthesia

Background: Whereas induction and recovery will occur more rapidly with the new low soluble anaesthetics than with isoflurane, the quality of anaesthe sia and recovery with special emphasis on postoperative nausea and vomiting (PONV) is not well known. Methods: In an open (peroperatively), double-blinded (postoperatively), ran domised controlled study, we assessed anaesthesia characteristics, recovery and 24 h PONV after breast surgery comparing isoflurane, desflurane and se voflurane. Results: There were no significant quality differences between the three ag ents during anaesthesia and recovery except for the incidence of PONV in th e postanaesthesia care unit (PACU). The PONV rate (24 h in PACU and ward) w as higher in the desflurane group (67%) than in the isoflurane group (22%), (P<0.01). The corresponding PONV rate for sevoflurane was 36%. Conclusion: The quality of anaesthesia, time to opening of eyes and influen ce on respiration was similar with all three anaesthetics. As the emergence from anaesthesia did not differ significantly between the three agents, th e choice of agent could be based on PONV rate and price. Desflurane had a s ignificantly higher 24 h PONV rate than isoflurane. Early PACU PONV rate wa s significantly (P<0.05) lower for the more soluble isoflurane (4%) than fo r the low soluble gases, desflurane and sevoflurane together (28%). The res ult of this study does not give a rationale for a transition to the new low soluble agents in breast cancer surgery. (C) Acta Anaesthesiologica Scandinavica 44 (2000).