***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We compared postoperative recovery after desflurane ( n = 25 ) versus sevoflurane ( n = 25 ) anesthesia in morbidly obese adults ( body mass index ≥35 ) who underwent gastrointestinal bypass surgery via an open laparotomy . After premedication with midazolam and metoclopramide 1 h before surgery , epidural catheter placement , induction of anesthesia with fentanyl and propofol , and tracheal intubation facilitated with succinylcholine , anesthesia was maintained with age-adjusted 1 minimum alveolar concentration ( MAC ) desflurane or sevoflurane . Fentanyl IV , morphine or local anesthetics epidurally , and vasoactive drugs as needed were used to maintain arterial blood pressure at ±20 % of baseline value and to keep bispectral index of the electroencephalogram values between 40 to 60 U. Although patients were anesthetized with desflurane for a longer time ( 261 ± 50 min versus 234 ± 37 min , mean ± sd ; P < 0.05 , desflurane versus sevoflurane , respectively ) and for more MAC-hours ( 4.2 ± 0.9 h versus 3.7 ± 0.8 h ; P < 0.05 ) , significantly earlier recovery of response to comm and and tracheal extubation occurred in patients given desflurane than in patients given sevoflurane . The modified Aldrete score was greater in desflurane-anesthetized patients on admission to the postanesthesia care unit ( PACU ) ( P = 0.01 ) but not at discharge ( P = 0.47 ) . On admission to PACU , patients given desflurane had higher oxygen saturations ( 97.0 % ± 2.4 % ) than patients given sevoflurane ( 94.8 % ± 4.4 % , P = 0.035 ) . Overall , the incidence of postoperative nausea and vomiting and the use of antiemetics did not differ between the two anesthetic groups . We conclude that morbidly obese adult patients who underwent major abdominal surgery in a prospect i ve , r and omized study awoke significantly faster after desflurane than after sevoflurane anesthesia and the patients anesthetized with desflurane  had higher oxygen saturation on entry to the PACU BACKGROUND To investigate whether the effects of desflurane on inspiratory resistance are similar to those of isoflurane and sevoflurane during 30 min administration at 1 and 1.5 MAC in patients with healthy lungs . METHODS Seventy-one patients undergoing elective surgery were r and omly assigned to receive isoflurane , sevoflurane , or desflurane . Baseline inspiratory resistance was obtained after intubation and establishment of volume control ventilation . Anaesthesia was maintained with desflurane , isoflurane , or sevoflurane at 1 MAC for 30 min followed by 1.5 MAC for another 30 min . Tidal volume , flow , and inspiratory pressures were continuously recorded with a pneumotachograph . Total inspiratory resistance ( R(rs ) ) , minimal resistance ( R(min ) ) , and effective resistance ( D(Rrs ) ) were calculated every 5 min using the end-inspiratory occlusion technique . RESULTS No significant differences of the evaluated parameters ( R(rs ) , R(min ) and D(Rrs ) ) were observed during administration of the three agents at 1 MAC for 30 min . At 1.5 MAC , desflurane caused a maximum increase in R(rs ) by 26 % and in R(min ) by 30 % above baseline , in contrast to isoflurane and sevoflurane which did not display a significant effect on R(rs ) ( + 3.7 % by isoflurane and + 7.6 % by sevoflurane ) and R(min ) ( + 4.7 % by isoflurane and + 9.6 % by sevoflurane ) . All parameters returned to baseline after discontinuation of the volatile agent . CONCLUSIONS In healthy adults , neither sevoflurane nor isoflurane produced bronchodilation at 1 and 1.5 MAC . Desflurane did not affect respiratory resistance at 1 MAC , but at 1.5 MAC caused significant increase in both total and airway resistance with return to near baseline values after discontinuation of the agent STUDY OBJECTIVE To determine if desflurane results in a faster emergence as measured by time to eye opening compared to sevoflurane in morbidly obese patients undergoing laparoscopic gastroplasty . STUDY DESIGN Prospect i ve , r and omized , double-blinded study . SETTING Tertiary care hospital . PATIENTS 70 patients with a body mass index of 35 or higher undergoing laparoscopic gastroplasty . INTERVENTIONS Patients were r and omized into two groups to receive either desflurane or sevoflurane for maintenance of general anesthesia . MEASUREMENTS Intraoperative measured variables included the time from when the inhalation agent was turned off ( no agent delivered ) to eye opening and the time from when the inhalation agent was turned off to extubation . Postanesthesia care unit (PACU)-measured variables on admission and at 15 minute intervals until discharge included oxygen saturation ( Spo2 ) , blood pressure , heart rate , pain and nausea Visual Analog Scale ( VAS ) scores , emesis , modified Aldrete score , and Mini-Mental Status ( MMS ) examination score . MAIN RESULTS No differences were noted in demographic data , total surgical operative time , times from turning inhalation agent off to eye opening and extubation , or average length of stay in PACU . No differences were noted with respect to pain VAS , treatment for pain , modified Aldrete scores , emesis , or treatment for postoperative nausea or emesis . Differences were noted in PACU nausea VAS at 15 minutes , PACU nausea VAS at discharge , and PACU-MMS score at 45 minutes ; however , multivariate analysis of variance revealed no differences between groups over the repeated PACU measured time periods in nausea VAS ( P=0.17 ) or in MMS ( P=0.34 ) . Higher heart rates in the desflurane group were observed during PACU admission ( 82.3+/-9.8 vs 74.4+/-13.4 bpm , P<0.01 ) and 15 minutes post PACU admission ( 79.4+/-12.1 vs 71.3+/-13.2 bpm , P=0.01 ) . CONCLUSIONS In morbidly obese patients undergoing laparoscopic gastroplasty , emergence , as measured by time to eye opening , did not differ between desflurane and sevoflurane , with similar recovery characteristics STUDY OBJECTIVE Morbid obesity is associated with significant comorbidities . Desflurane has a low fat-blood solubility coefficient and may be better suited in this population to achieve a rapid emergence ; however , sevoflurane has favorable cardiorespiratory properties that might also prove advantageous in the morbidly obese ( MO ) patient . This study used careful drug titration to determine if emergence differences between sevoflurane and desflurane could be minimized in MO patients . DESIGN A r and omized , prospect i ve blinded study to determine the emergence profiles of desflurane and sevoflurane in MO patients when anesthetic drug titration is used . SETTING Operating room of the VA Medical Center , Milwaukee , Wis. PATIENTS Forty American Society of Anesthesiologists II and III , MO patients ( body mass index > or = 35 kg/m2 ) , who were scheduled for elective surgery predicted to last for more than 2 hours , were studied . INTERVENTIONS Patients were induced with fentanyl , midazolam , and propofol and maintained with desflurane or sevoflurane , mixed in air and oxygen .  Intraoperative bispectral index ( BIS ) was targeted to 45 to 50 and to 60 in the last 15 minutes of surgery . MEASUREMENTS Intraoperative anesthetic concentration , BIS , and hemodynamics were recorded . During emergence , time to follow comm and and extubation were noted , with assessment s of cognitive function via the Mini-Mental Status Test and psychomotor performance via the Digit Symbol Substitution Test . A blinded observer recorded key recovery events . MAIN RESULTS Demographic data ( age , 61 [ 36 - 83 ] years ; body mass index , 38 [ 35 - 47 ] kg/m2 ) , surgical procedures , length of anesthesia ( approximately 3.5 hours ) , adjuvant drugs , and intraoperative BIS , heart rate , and mean arterial pressure were not significantly different . Hemodynamics , time to follow comm and s and to extubation , and results of Digit Symbol Substitution Test and Mini-Mental Status Test did not differ between anesthetic groups during recovery . CONCLUSIONS There were no differences in emergence and recovery profiles in MO patients receiving desflurane or sevoflurane when anesthetic concentration was carefully titrated BACKGROUND The concept of an ' inhalation bolus ' can be used to optimize inhaled drug administration . We investigated the depth of anaesthesia , haemodynamic stability , and recovery time in morbidly obese patients result ing from bispectral index (BIS)-guided sevoflurane or desflurane administration and BIS-triggered inhalation boluses of sevoflurane or desflurane combined with titration of remifentanil . METHODS Fifty morbidly obese patients undergoing laparoscopic gastroplasty received either BIS-guided sevoflurane or desflurane anaesthesia in combination with a remifentanil target-controlled infusion . Intraoperative haemodynamic stability and BIS control were measured . Immediate recovery was recorded . RESULTS Intraoperatively , the BIS was between 40 and 60 for a greater percentage of time in the sevoflurane ( 78 (13)% of case time ) than in the desflurane patients ( 64 (14)% of case time ) , owing to too profound anaesthesia in the desflurane patients at the start of the procedure . However , fewer episodes of hypotension were found in the desflurane group , without the occurrence of more hypertensive episodes . During immediate recovery , eye opening , extubation , airway maintenance , and orientation occurred sooner in the desflurane group . CONCLUSIONS Immediate recovery was significantly faster in the desflurane group . Overall hypnotic controllability measured by BIS was less accurate with desflurane .  Overall haemodynamic controllability was better when using desflurane . Fewer episodes of hypotension were found in the desflurane group . The use of the inhalation bolus was found to be appropriate in both groups without causing severe haemodynamic side effects . Minimal BIS values were significantly lower after a desflurane bolus BACKGROUND The aim of this study was to compare desflurane vs sevoflurane kinetics and dynamics in morbidly obese patients and their recovery profile when no premedication had been used . METHODS Twenty-eight unpremedicated obese patients were r and omly allocated to receive either sevoflurane ( n = 14 ) or desflurane ( n = 14 ) as the main anaesthetic agent . After induction of anaesthesia , either sevoflurane 2 % or desflurane 6 % was administered for 30 min via a non-rebreathing circuit . The kinetics of sevoflurane and desflurane were determined by measuring and recording end-tidal sample s during this time . The bispectral index was used to indicate the level of hypnosis . At the end of the procedure , the end-tidal concentrations of sevoflurane and  desflurane were recorded during the first 5 min after stopping their administration . Time from discontinuation of the anaesthetic drugs to eye opening on verbal comm and , squeezing the observer 's h and on comm and , extubation , stating their name , giving their correct date of birth , discharge from the recovery room , and duration of the surgery and anaesthesia were also recorded . RESULTS The F(A)/F(I ) ratio was significantly higher in the desflurane group from the 15th to the 30th min . The wash-out phase was faster for desflurane during the total observation period . When desflurane was used , recovery was also faster . CONCLUSIONS Desflurane provides faster wash-in and wash-out than sevoflurane in morbidly obese patients , and recovery is much faster after desflurane administration when no premedication has been used We compared the recovery characteristics of remifentanil , desflurane , and sevoflurane when used for anesthesia in elective operative procedures . Sixty ASA physical status I and II patients , aged 18–65 yr , were r and omly assigned to receive remifentanil-propofol , desflurane-N2O , or sevoflurane-N2O anesthesia . Before the induction of anesthesia , the patients of the desflurane and sevoflurane groups received fentanyl 2 & mgr;g/kg . In all groups , anesthesia was induced with propofol and maintained either with remifentanil 0.25 & mgr;g · kg−1 · min−1 , desflurane , or sevoflurane 0.85 MAC with 65 % nitrous oxide in oxygen 
    Output:
    
There 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