The impact of intraoperative use of the inhaled anesthetic desflurane on postoperative recovery quality after noncardiac surgery: a meta-analysis of randomized controlled trials

Desflurane permits rapid emergence, but its effect on patient-reported recovery may depend on the comparator anesthetic. We reviewed randomized trials comparing desflurane with intravenous or other inhalational maintenance anesthetics in adults undergoing noncardiac surgery. PubMed, Embase, Scopus, CENTRAL, and Web of Science were searched from inception to 14 June 2025. Random-effects models were used with standardized mean differences (SMDs), mean differences, or risk ratios as appropriate. Eleven trials (1,155 participants) were included. Overall quality of recovery (QoR) on postoperative day 1 favored control (SMD − 0.30, 95% confidence interval (CI) − 0.54 to − 0.06; I 2 = 76%), with a significant comparator interaction ( p < 0.0001). Compared with intravenous anesthetics, desflurane was associated with lower QoR (9 trials; SMD − 0.45, 95% CI − 0.60 to − 0.29; I 2 = 26%); compared with other inhalational anesthetics, the estimate favored desflurane (2 trials; SMD 0.39, 95% CI 0.01 to 0.77; I 2 = 46%). QoR on postoperative days 2–3 favored control, whereas postanesthesia care unit duration and extubation time showed no clear differences. Postoperative nausea and vomiting may be more frequent with desflurane. The effect of desflurane on postoperative QoR appears comparator-dependent, and evidence against other inhalational anesthetics remains limited. The review was registered in PROSPERO (CRD420251074022).