Article

Sevoflurane versus desflurane for outpatient anesthesia: A comparison of maintenance and recovery profiles

Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas 75235-9068, USA.
Anesthesia & Analgesia (Impact Factor: 3.47). 01/1996; 81(6):1186-90. DOI: 10.1097/00000539-199512000-00012
Source: PubMed

ABSTRACT

The recovery characteristics of desflurane and sevoflurane were compared when used for maintenance of ambulatory anesthesia. After obtaining informed consent, 42 healthy, unpremedicated women undergoing laparoscopic sterilization procedures were studied. Anesthesia was induced with propofol, 1.5-2.0 mg/kg, and maintained with either desflurane 3%-6% (n = 21) or sevoflurane 1%-2% (n = 21) with 60% nitrous oxide in oxygen. Intraoperative analgesia and neuromuscular block was achieved using fentanyl and vecuronium, respectively. The inhaled anesthetics were titrated to achieve an adequate clinical "depth of anesthesia" and to maintain mean arterial pressure (MAP) within 20% of the preinduction baseline values. Visual analog scales (VAS) and the digit-symbol substitution test (DSST) were performed preoperatively and at 30-min intervals during the recovery period. There were no differences between the two groups in the total doses of propofol, fentanyl, or vecuronium. Heart rate (HR) values were lower in the sevoflurane group during the induction-to-incision period. However, HR and MAP were otherwise similar during the maintenance and recovery periods. Use of desflurane led to a more rapid emergence (4.8 +/- 2.4 vs 7.8 +/- 3.8 min) and shorter time to extubation (5.1 +/- 2.2 vs 8.2 +/- 4.2 min) compared to sevoflurane (mean values +/- SD). Intermediate recovery times, postoperative VAS and DSST scores, and side effects were similar in the two treatment groups. Although sevoflurane was associated with a slower emergence from anesthesia than desflurane after laparoscopic surgery, recovery of cognitive function and discharge times were similar in the two anesthetic groups. Thus, it would appear that sevoflurane is an acceptable alternative to desflurane for maintenance of outpatient anesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

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Available from: Paul F White, Apr 17, 2015
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    • "The time to extubation and emergence was significantly shorter in desflurane group. Numerous studies carried out in varied patient populations,[14,15]have demonstrated early recovery with desflurane as compared to sevoflurane. Cohen et al.[1]observed desflurane providing early emergence and recovery as compared to sevoflurane in children undergoing adenoidectomy. "
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    • "Higher intra-abdominal pressure following carboperitoneum tends to collapse the major abdominal veins and decreases venous return, thus leading to a drop in preload and cardiac output.[4] Sevoflurane and desflurane provided similar intraoperative conditions during the maintenance period.[5] The present study also demonstrates that both, desflurane and sevoflurane, provide comparable hemodynamic stability in morbidly obese patients for prolonged laparoscopic surgical procedures. "
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    ABSTRACT: Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications. Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery. Randomized controlled trial. After institutional ethics committee approval and written informed consent, 40 morbidly obese patients (BMI > 35 kg/m(2)) were randomized to receive desflurane or sevoflurane as part of a standardized 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). Intraoperative MAP and HR did not differ between the two groups (P > 0.05). The time to response to painful stimuli, obeying verbal commands 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). 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.
    No preview · Article · Mar 2013 · Journal of Anaesthesiology Clinical Pharmacology
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    • "Nathanson et al. [19] compared the two inhalational anesthetics (desflurane and sevoflurane) in outpatients. They reported that the group induced with desflurane had significantly higher HR compared to the group induced with sevoflurane, which was what the results of the present study also showed. "
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    Full-text · Article · Feb 2013 · Korean journal of anesthesiology
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