AMBULATORY ANESTHESIA SECTION EDITOR PAUL F. WHITE SOCIETY FOR AMBULATORY ANESTHESIA Fast-Track Eligibility After Ambulatory Anesthesia: A Comparison of Desflurane, Sevoflurane, and Propofol Dajun Song, MD, rhD, Girish P. Joshi, MB BS, MD, FFARCSI, and Paul F. White, rhD, MD, FANZCA Department of Anesthesiology and Pain Management, University of TexasSouthwestern Medical Center at Dallas, Dallas, Texas This study was designed to test the hypothesis that us- ing the less solublevolatile anesthetics, desflurane and sevoflurane, as alternatives to propofol for mainte- nance of anesthesia facilitates the ability of outpatients to achieve postanesthesia care unit (PACU) discharge criteria (i.e., fast-track eligibility) on arrival in the PACU after laparoscopic surgery. One hundred- twenty consenting women undergoing laparoscopic tubal ligation procedures were randomly assigned to one of three treatment groups. After a standardized in- duction of anesthesia and tracheal intubation sequence, anesthesia was maintained with either desflurane 2%- 6%, sevoflurane 0.6%-1.75%, or propofol 50-150 pg . kg-’ *min -’ in combination with nitrous oxide 60%in oxygen. Recovery times, postanesthesia recovery scores, and the number and type of therapeutic inter- ventions in the PACU were recorded. Compared with the propofol group, the times to awakening and to achieve a recovery score of 10 were significantly shorter, and the percentage of patientsjudged fast-track eligible on arrival in the PACU wassignificantly higher, in the desfluraneand sevoflurane groups (90% and 75% vs 26%). In conclusion, compared with propofol, the useof desfluraneand sevoflurane for the maintenance of generalanesthesia resulted in a higher percentage of patientsbeingjudged fast-track eligible after outpatient laparoscopic tubal ligation procedures. Implications: Bypassing the recovery room by transferring outpa- tients directly to the step-down unit after ambulatory surgery (“fast-tracking”) could result in significant cost-savings. We examined the effectsof three different maintenance anesthetics-desflurane, sevoflurane, and propofol-on the fast-track eligibility of outpa- tients after laparoscopictubal ligation surgery. Com- pared with propofol, desflurane and sevoflurane re- sulted in a higher percentage of outpatients being judged eligible for fast-tracking. (Anesth Analg 1998;86:267-73) 0 utpatients receiving general anesthesia are usu- ally transferred from the operating room (OR) to the postanesthesia care unit (PACU) and then to the Phase II (step-down) unit when they have ful- filled the PACU discharge criteria. The availability of rapid and shorter-acting intravenous (IV) (e.g., propo- fol) and volatile (e.g., desflurane and sevoflurane) an- esthetics has facilitated early recovery in the ambula- tory setting. Therefore, patients can be completely awake’and oriented, breathing comfortably, with sta- ble vital signs in the OR shortly after a brief ambula- tory surgical procedure under general anesthesia. If the criteria used to discharge patients from the PACU are met in the OR, it would be appropriate to consider Presented in part at the annual meeting of the International Anesthesia Research Society, San Francisco, CA, March 1997. Accepted for publication October 1, 1997. Address correspondence and reprint requests to Dr. Paul F. White, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, 5161 Harry Hines Blvd., CS 2.202, Dallas, TX 75235-9068. Address e-mail to pwhite@mednet.swmed.edu. 01998 by the International Anesthesia Research Society 0003.2999/98/$5.00 bypassing the PACU and transferring the patient di- rectly to the step-down unit. This process is known as “fast-tracking” after ambulatory surgery (1). A recent study in volunteers reported that awaken- ing and early psychomotor recovery was faster using desflurane compared with propofol (2). We hypothe- sized that the use of newer, less soluble, volatile an- esthetics (i.e., desflurane and sevoflurane) as alterna- tives to propofol for the maintenance of general anesthesia would provide for a more rapid emergence from anesthesia and thereby facilitate fast-tracking of outpatients undergoing ambulatory surgery. There- fore, we designed a prospective, randomized, con- trolled clinical study to evaluate the effect of the choice of the maintenance anesthetic on the ability of outpatients to rapidly achieve PACU discharge crite- ria after gynecologic laparoscopic procedures. The ef- fect of the maintenance anesthetic on the postanesthe- sia recovery scores and need for PACU nursing interventions were also assessed in this outpatient population. Anesth Analg 1998;86:267-73 267