Sevoflurane versus desflurane for early postoperative vomiting after general anesthesia in hospitalized adults: A systematic review and meta-analysis of randomized controlled trials

Study objective: This systematic review and meta-analysis aimed at assessing the effects of two commonly used anesthetics in general anesthesia (GA), sevoflurane and desflurane, on early postoperative vomiting (POV) in hospitalized adults. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: Early postoperative vomiting after GA. Patients: A total of 266 adult patients receiving inpatient surgeries under GA maintained with sevoflurane or desflurane. Interventions: We searched PubMed, Medline, Cochrane Central Register of Controlled Trials, ScienceDirect, and Embase for eligible RCTs comparing postoperative outcomes following sevoflurane- or desflurane-maintained anesthesia. Measurements: The primary outcome was early POV. Secondary outcomes included late POV, early and late postoperative nausea (PON), time to extubation, and emergence time. Main results: Eight trials were included. There was no significant difference in the risk of early POV (risk ratio [RR] 1.03, 95% confidence interval [CI] 0.64-1.64, p = 0.91). No significant difference in early PON was observed (RR 1.09; 95% CI, 0.77-1.56; p = 0.62). Nevertheless, the incidence of late POV and late PON were significantly lower in the sevoflurane group than that in the desflurane group (RR 0.47, 95% CI 0.23-0.94, p = 0.03; RR 0.45, 95% CI 0.24-0.84, p = 0.01, respectively). The extubation time was longer in the sevoflurane group than in the desflurane group (standardized mean difference [SMD] 0.56, 95% CI 0.14-0.97, p = 0.009). The emergence time of patients in the sevoflurane group was longer than that in those receiving desflurane (SMD 0.76, 95% CI 0.1-1.42, p = 0.02). Conclusions: Desflurane had the same effects on early POV and early PON as sevoflurane. However, the association between late POV and late PON with desflurane was stronger than that with sevoflurane if the effects of opioids were not considered. The desflurane group had shorter time to extubation and emergence time than the sevoflurane group. PROSPERO registration number: CRD42020218988.