***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 
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    ***EXAMPLES*** 
    Input: Background : The aims of the study were to evaluate costs and clinical characteristics of desflurane‐based anaesthetic maintenance versus propofol for outpatient cholecystectomy Background A multidisciplinary effort was undertaken to determine whether patients could safely bypass the postanesthesia care unit ( PACU ) after same-day surgery by moving to an earlier time point evaluation of recovery criteria . Methods A prospect i ve , outcomes research study with a baseline month , an intervention month , and a follow-up month was design ed . Five surgical centers ( three community-based hospitals and two freest and ing ambulatory surgical centers ) were utilized . Two thous and five hundred eight patients were involved in the baseline period , and 2,354 were involved in the follow-up period . Outcome measures included PACU bypass rates and adverse events . Intervention consisted of a multidisciplinary educational program and routine feedback reports . Results The overall PACU bypass rate ( 58 % ) was significantly different from baseline ( 15.9 % , P < 0.001 ) , for patients to whom a general anesthetic was administered ( 0.4–31.8 % , P < 0.001 ) , and for those given other anesthetic techniques ( monitored anesthesia care , regional or local anesthetics ; 29.1–84.2 % , P < 0.001 ) . During the follow-up period , the average ( SD ) recovery duration for patients who bypassed the PACU was significantly shorter compared to that for patients who did not bypass , 84.6 ( 61.5 ) versus 175.1 ( 98.8 ) min , P < 0.001 , with no change in patient outcome . Patients receiving only short-acting anesthetics were 78 % more likely ( P < 0.002 ) to bypass the PACU after adjusting for various surgical procedures . Conclusions This study represents a substantial change in clinical practice in the perioperative setting . Same-day surgical patients given short-acting anesthetic agents and who are awake , alert , and mobile requiring no parenteral pain medications and with no bleeding or nausea at the end of an operative procedure can safely bypass the PACU This r and omized , open-label study compared the investigational inhalational anesthetic sevoflurane with isoflurane in 47 healthy women undergoing elective ambulatory surgery . The women were r and omized to receive either sevoflurane or isoflurane in 60 % nitrous oxide-oxygen . Induction with thiopental 3 - 6 mg/kg was followed by vecuronium 0.1 mg/kg and fentanyl 0 - 200 micrograms . Duration of anesthesia , time to emergence , orientation , length of stay in the surgical unit , and hospital discharge were recorded . The emergence , length of stay , and discharge times after discontinuation of sevoflurane were 9.7 + /- 0.7 , 120.6 + /- 8.0 , and 244 + /- 15 minutes , respectively , and for isoflurane were 11.9 + /- 1.4 , 106.8 + /- 7.1 , and 282 + /- 24 minutes , respectively ( NS ) . The isoflurane group had a higher frequency of postoperative cough . At the end of surgery , the sevoflurane group received a deeper level of anesthesia ( minimum alveolar concentration 1.5 vs 1.3 ) , however , these patients were oriented earlier ( 13.6 + /- 1.1 min vs 17.0 + /- 1.5 min isoflurane ; p = 0.02 ) after discontinuation of anesthesia , although this difference is of little clinical significance We have assessed general anaesthesia for day-case cataract surgery in 40 patients more than 60 yr of age . The patients were allocated r and omly to receive either an infusion of propofol or etomi date -vecuronium-isoflurane anaesthesia . Patients in the propofol group experienced significant reductions in mean arterial pressure ( 42 % ) during anaesthesia . In the etomi date -vecuronium-isoflurane group there was a significant increase in both mean arterial pressure ( 19 % ) and heart rate ( 21 % ) with intubation . During maintenance of anaesthesia in this group , mean arterial pressure and heart rate decreased to 88 % and 80 % of awake values . Both techniques produced similar reductions in intraocular pressure . Recovery times from cessation of anaesthesia to spontaneous eye opening and ability to give correct date of birth were significantly shorter in the etomi date -isoflurane group . Two hours after surgery there were no significant differences between the groups and cognitive mental function tests were similar to preoperative values . All patients were deemed fit for discharge home 2 h after surgery . We conclude that it is feasible to provide general anaesthesia for day-case cataract surgery . Etomi date -vecuronium-isoflurane anaesthesia appeared to be superior to propofol in this age group as it was associated with less hypotension and a more rapid recovery IMPLICATION S In this study , although 41%-94 % of the patients were fast-track eligible after laparoscopic surgery , only 35%-53 % of the patients actually bypassed the postanesthesia care unit ( PACU ) because of anesthetic-related factors and surgical complications .  Residual sedation  was the most common anesthetic-related cause of failure to bypass thePACU Propofol was used to induce anaesthesia in 60 patients undergoing minor outpatient gynaecological procedures . Maintenance was with 66 % nitrous oxide in oxygen , plus either isoflurane or 10-mg increments of propofol . Recovery was assessed using both clinical and psychomotor criteria and the results compared with those obtained in a non-anaesthetized control group . As far as the two test groups were concerned , initial recovery was more rapid in the incremental propofol group but , by 1 h after surgery , there were no differences between all three groups We have compared the recovery characteristics of four different techniques for maintenance of anaesthesia in 99 day-case patients admitted for oral surgery . All patients received propofol for induction of anaesthesia followed by halothane , enflurane , isoflurane or propofol infusion for maintenance of anaesthesia . Each patient was subjected to a battery of psychometric tests which included Spielberger state , trait , mood stress and mood arousal question naires , Maddox-Wing test and five-choice serial reaction time . All tests were performed before operation and at 0.5 , 1 , 2 , 4 , 24 and 48 h after operation . Performance in the reaction time test decreased significantly in the immediate postoperative period , returning almost to preoperative values by 4 h. However , only those patients who received enflurane or propofol had returned to their performance level before surgery by 4 h , although all four groups had achieved this target by 24 h. There was a further improvement in performance at 48 h. Anxiety and stress were high before surgery and decreased rapidly in the postoperative period . The Maddox-Wing test demonstrated a significant impairment in performance in the first 1 h after surgery , which returned to normal by discharge at 4 h. There were no significant differences between the four groups in these latter tests UNLABELLED We design ed this study to evaluate postural stability in out patients after either desflurane or propofol anesthesia .  After IRB approval , 120 consenting women undergoing gynecological laparoscopic procedures were r and omly assigned to receive either desflurane or propofol-based general anesthesia . After surgery , patients ' postural stability was measured as body sway velocity by using a computerized force platform in the following conditions : 1 ) st and ing on a firm surface with eyes open versus closed and 2 ) st and ing on a foam surface with eyes open versus closed . These measurements were made before anesthesia , immediately after the patient achieved a Post-Anesthesia Discharge Score of 9 , and at actual discharge home . At the time patients first achieved a Post-Anesthesia Discharge Score of 9 , the body sway in the Propofol group was significantly more than in the Desflurane group when patients were asked to st and on a foam surface with eyes closed ( testing the ability of using vestibular information for balance control ) . We concluded that the desflurane-based anesthetic was associated with better postural control than the propofol-based anesthetic in the early recovery period after outpatient gynecological laparoscopic procedures . IMPLICATION S The residual effects of the short-acting general anesthetics desflurane and propofol on patient 's balance function during recovery after surgery were assessed with a computerized force platform . The results showed that desflurane seemed to be associated with better postural control than propofol in the early recovery period BACKGROUND The goal of this multicenter , prospect i ve , r and omized clinical investigation was to compare the clinical efficacy and safety of sevoflurane and isoflurane during the maintenance of and the recovery from general anaesthesia in elderly patients . METHODS With the approval of the Ethical Committee and the patient informed consent , 104 ASA physical status II-III patients , aged more than 65 years , were r and omized in order to receive either isofluorane ( n = 54 ) or sevoflurane ( n = 50 ) as the main general anaesthetic . After an oral diazepam ( 0.1 - 0.2 mg kg-1 ) and intramuscular atropine ( 0.007 - 0.01 mg kg-1 ) premedication , anaesthesia was induced intravenously and then maintained by adjusting the end-tidal concentrations of the inhalation agent for the maintainance of cardiovascular stability . At the moment of the last skin suture the inhalational agents were discontinued and the neuromuscular block was reversed . The following times were recorded : time of extubation , time of eyes opening , time of comm and response and readiness for discharge . The occurrence of untoward event throughout the study was also recorded . Before surgery and 24 hr after the procedure , blood was collected in order to assess renal function . RESULTS No differences in demography , duration of surgery , exposure to the volatile anaesthetic , and renal function laboratory values were observed between the two groups . The time of extubation ( median : 8 min versus 11 min , p < 0.01 ) , emergence ( median : 8.5 min versus 12.5 min , p < 0.01 ) , comm and response ( median : 10 min versus 15.5 min , p < 0.01 ) , and suitability for discharge from the recovery area ( median : 21 min versus 27.5 min , p < 0.01 ) were shorter in the sevoflurane group than in the isoflurane one . The success rate ( absence of any event ) during induction and maintenance periods was better in sevoflurane than isoflurane group ( p < 0.02 and p < 0.001 , respectively ) . Hypotension ( systolic arterial blood pressure decrease > 30 % of baseline values ) was observed in 16 patients receiving isoflurane ( 29 % ) and only in 5 patients receiving sevoflurane ( 10 % ) ( p < 0.02 ) . DISCUSSION When used in elderly patients undergoing operations of intermediate duration , sevoflurane provides a more rapid emergence from anaesthesia with a faster fulfillment of discharging criteria , and a more stable cardiovascular homeostasis than isoflurane .  Renal function also appears to be equally well preserved with both anaesthetics Forty patients agreed to participate in a study to compare whether fentanyl or alfentanil used as analgesic is associated with quicker recovery following anaesthesia for outpatient arthroscopy procedure . Psychomotor tests including choice reaction time ( CRT ) , perceptive accuracy test ( PAT ) and finger tapping test ( FTT ) were done prior to induction of anaesthesia with propofol ( 2–3 mg – kg‐1 ) . Patients were then divided into two groups : Group F ( fentanyl ) received 0.1 mg fentanyl prior to start of surgery and thereafter 0.05 mg every 30 min during the procedure . Group A ( alfentanil ) received 0.5 mg alfentanil prior to the onset of surgery and 0.25 mg every 15 min thereafter . Anaesthesia was then maintained using isoflurane ( 0.5–2 % ) in oxygen and air ( Fio2 0.33 ) during spontaneous respiration with a face mask in a Bain 's system . Psychomotor tests were repeated every 45 min postoperatively . Clinical recovery , visual analogue pain intensity score ( VAS ) and time to discharge home were also assessed by a nurse blind to the method used . Patients in Group A returned to baseline values on the FTT after 90 min while those in Group F did not return to baseline values until 135 min after the end of the operation . Clinical recovery and time to discharge home ( “ home ready ” ) were also significantly longer in Group F. There was no difference in recovery as seen in the PAT and CRT between the groups . Also , there was no difference in the incidence of side effects and the pain intensity ( VAS ) scores were similar in the two groups at all time periods . We conclude that recovery following alfentanil is quicker compared to fentanyl when anaesthesia is based on isoflurane Desflurane is an ether halogenated exclusively with fluorine . It has a blood/gas partition coefficient of 0.42 
    Output:
    
No differences were found between propofol and isoflurane in early recovery .
However , early recovery was faster with desflurane compared with propofol and isoflurane and with sevoflurane compared with isoflurane .
We conclude that the differences in early recovery times among the different anesthetics were small and in favor of the inhaled anesthetics .
The incidence of side effects , specifically postoperative nausea and vomiting , was less frequent with propofol .
IMPLICATION S A systematic analysis of the literature comparing postoperative recovery after propofol , isoflurane , desflurane , and sevoflurane-based anesthesia in adults demonstrated that early recovery was faster in the desflurane and sevoflurane groups .
The incidence of nausea and vomiting were less frequent with propofol