LAUSR

Sleep apnea is associated with negative outcomes after general anesthesia. Current recommendations suggest using short-acting over standard anesthetic agents to reduce this risk, but there is currently no evidence to support this. This randomized controlled triple-blind trial tested the hypothesis that a combination of short-acting agents (desflurane-remifentanil) would reduce the postoperative impact of general anesthesia on sleep apnea severity compared with standard agents (sevoflurane-fentanyl). Sixty patients undergoing hip arthroplasty under general anesthesia were randomized to anesthesia with desflurane-remifentanil or sevoflurane-fentanyl. Respiratory polygraphy was performed before surgery and on the first and third postoperative nights. The primary outcome was the supine apnea-hypopnea index on the first postoperative night. Secondary outcomes were the supine apnea-hypopnea index on the third postoperative night, and the oxygen desaturation index on the first and third postoperative nights. Additional outcomes included intravenous morphine equivalent consumption and pain scores on postoperative days 1, 2 and 3. Preoperative sleep study data were similar between groups. Mean (95% confidence interval) values for the supine apnea-hypopnea index on the first postoperative night were 18.9 (12.7-25.0) and 21.4 (14.2-28.7) events/h, respectively, in the short-acting and standard anesthesia groups (p=0.64). Corresponding values on the third postoperative night were 28.1 (15.8-40.3) and 38.0 (18.3-57.6) events/h (p=0.34). Secondary sleep- and pain-related outcomes were generally similar in the two groups. Short-acting anesthetic agents did not reduce the impact of general anesthesia on sleep apnea severity compared with standard agents. These data should prompt an update of current recommendations. SNSF