***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 Previous studies have noted a high incidence of adverse outcomes in the postanesthesia care unit ( PACU ) , but few have examined associated factors and patient outcomes . To determine the frequency of acute , unanticipated respiratory problems and to examine the associated patient , surgical , and anesthetic factors , we prospect ively collected preoperative , intraoperative , and postoperative data on 24,157 consecutive PACU patients who received a general anesthetic during a 33-month period . Methods A PACU critical respiratory event ( CRE ) , was defined as any unanticipated hypoxemia ( hemoglobin oxygen saturation < 90 % ) , hypoventilation ( respiratory rate < 8 breaths/min or arterial carbon dioxide tension > 50 mmHg ) or upper-airway obstruction ( stridor or laryngospasm ) requiring an active and specific intervention ( ventilation , tracheal intubation , opioid or muscle relaxant antagonism , insertion of oral/nasal airway or airway manipulation ) . These problems were documented by PACU nurses whereas data on case-mix , surgical factors , and intraoperative management were retrieved from the anesthetic record . Significant patient , surgical , and anesthetic factors were identified by logistic regression analysis . Other morbidity experienced by patients with a CRE was also noted . Results For patients given general anesthesia  the risk of a CRE was 1.3 % ( hypoxemia 0.9 % , hypoventilation 0.2 % , airway obstruction 0.2 % ) . Preoperative factors that increase risk were age > 60 yr , male gender , diabetes , and obesity ( P < 0.05 ) . Patients who underwent operative procedures on an emergency basis and whose operation was longer than 4 h were also at increased risk , but those undergoing perineal procedures were at lower risk ( P < 0.05 ) . Anesthetic risk factors ( P < 0.05 ) included opioid premedication ( relative odds 1.8 ) , sedatives preoperatively ( 2.0 ) , fentanyl > 2.0 μg.kg–1.h–1 as the sole opioid ( 1.9 ) , fentanyl used in combination with morphine ( 1.6 ) and atracurium ≥ 0.25 mg.kg–1.h–1 ( 2.2 ) . Patients in whom anesthesia was induced with thiopental ( relative odds 2.5 ) , compared with those who received propofol for induction , were also at increased risk of a CRE . Patients with a CRE stayed longer in PACU , had higher rates of unanticipated admissions to the intensive care unit and were more likely to have PACU cardiac problems ( P < 0.01 ) . Conclusions A CRE is relatively rare . Multiple patient and surgical factors and specific aspects of anesthetic management are associated with the occurrence of a CRE in the PACU Background : The choice of anesthetic technique for general anesthesia in morbidly obese patients remains controversial . We aim ed to compare blood gases , recovery and hemodynamic parameters using TIVA and sevoflurane anesthesia in bariatric surgery . Methods : The study was performed with permission of the ethics committee . We studied 40 morbidly obese patients allocated to 2 groups . The total I.V. anesthesia ( TIVA ) group was named Group T , and the sevoflurane group was named Group S. In Group T , anesthesia induction was achieved with propofol . In Group S , anesthesia induction was achieved by sevoflurane with single breath technique , with maintenance provided with 1 - 2 % volume sevoflurane . Student t , Chi square and ANOVA tests were used for data analysis ; p-value < 0.05 was considered statistically significant . Results : There was no significant difference between the 2 groups in demographic data , blood gas values and recovery characteristic . Hemodynamic values were significantly lower in Group T than Group S , during and after the operative period . Conclusion : While sevoflurane induction and maintenance is a suitable anesthetic modality for obese patients , TIVA can be applied easily in those patients possessing no extra risk factors other than morbid obesity 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 Context : Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications . Aim : Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery . Setting s and Design : R and omized controlled trial Material s and Methods : After institutional ethics committee approval and written informed consent , 40 morbidly obese patients ( BMI > 35 kg/m2 ) were r and omized to receive desflurane or sevoflurane as part of a st and ardized general anesthesia technique . Volatile anesthetic concentration was titrated to maintain electroencephalographic bispectral index score ( BIS ) in the range of 40 - 60 . Mean arterial pressure ( MAP ) and heart rate ( HR ) were recorded preoperatively , at induction and intubation , then at regular intervals . After extubation , early recovery was recorded by time to emergence and orientation to time and place . In post anesthesia care unit , intermediate recovery was assessed by modified Aldrete Score and Digit Symbol Substitution Test ( DSST ) . Results : Intraoperative MAP and HR did not differ between the two groups ( P > 0.05 ) . The time to response to painful stimuli , obeying verbal comm and s and spontaneous eye opening was shorter ( P = 0.001 ) and modified Aldrete Score was higher after desflurane anesthesia than after sevoflurane anesthesia ( P = 0.049 ) . DSST also returned towards normal faster after desflurane ( 28.50 ± 6.30 min vs. 35.0 ± 5.62 min , P = 0.03 ) . Conclusions : Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients 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 : In this study , we evaluated the influence of propofol versus desflurane anesthesia in overweight patients on postoperative lung function and pulse oximetry values . METHODS : We prospect ively studied 134 patients with body mass indices of 25 to 35 kg/m2 undergoing minor peripheral surgery lasting 
    Output:
    
Conclusion Postoperative recovery was significantly faster after desflurane than after sevoflurane , isoflurane , or propofol anesthesia in obese patients .
No clinical ly relevant differences were observed regarding PACU discharge time , incidence of PONV , or postoperative pain scores .
Conclusion La récupération postopératoire a été significativement plus rapide après desflurane qu’après une anesthésie par sévoflurane , isoflurane ou propofol chez des patients obèses .
Aucune différence cliniquement pertinente n’a été observée concernant les délais de congé de la salle de réveil , l’incidence des nausées et vomissements postopératoires , ou des scores de douleur postopératoire .