Isoflurane and postoperative respiratory depression following laparoscopic surgery: A retrospective propensity-matched analysis

Abstract

Episodes of respiratory depression during the immediate postoperative recovery period (Phase I post-anesthesia recovery) have been associated with respiratory complications during Phase II recovery. Using multivariable analyses in several surgical cohorts, we previously identified potential associations between patient and perioperative factors and increased risk for Phase I respiratory depression. The aim of this study is to use the propensity-matched analysis to specifically assess for a potential association between the use of isoflurane and episodes of Phase I respiratory depression after laparoscopic operations. The electronic medical records of 8567 patients who underwent laparoscopic operations between January 1, 2010 and July 31, 2014, lasting ≥90 minutes, were retrospectively analyzed. Propensity-matched patients anesthetized without isoflurane were identified for 3403 patients anesthetized with isoflurane. Compared to the use of desflurane, sevoflurane or propofol infusion, maintenance of anesthesia with isoflurane was associated with an increased likelihood of Phase I respiratory depression (OR 95% CI, 1.32, 1.15-1.50, p < 0.001) and longer Phase I recovery (126 vs. 110 minutes, p < 0.001). The use of isoflurane was associated with increased rates of postoperative respiratory depression and postoperative recovery when compared to sevoflurane, desflurane, or propofol infusion.