Comparison of Recovery Profile and Cost-effectiveness of Sevoflurane and Desflurane using Low Flow Anaesthesia in Adults: A Randomised Clinical Study

Abstract

Introduction: Newer inhalational agents, like sevoflurane and desflurane, offer advantages of rapid induction and early recovery due to their low blood gas solubility. However, cost remains a major drawback of these agents, despite the reduction in agent consumption achieved through low flow anaesthesia. Aim: To evaluate the recovery profile and cost-effectiveness of sevoflurane and desflurane using low flow anaesthesia in adults. Materials and Methods: A randomised clinical study was conducted at, Department of Anaesthesia, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India, during October 2019 to August 2021, with 60 patients classified as American Society of Anaesthesiologists (ASA) I or II, aged 18-65 years, undergoing elective surgeries lasting 1-4 hours under general anaesthesia with the low flow technique. Group S received sevoflurane, while group D received desflurane. Anaesthesia was maintained using a 50/50 mixture of oxygen/air and either sevoflurane or desflurane, depending on the group. The inhalational agents were titrated intraoperatively to achieve a Minimum Alveolar Concentration (MAC) of approximately one. The amount of inhalational agent consumed was calculated, and recovery profiles were studied. The means of continuous variables were compared using an Independent sample t-test, with p-values <0.05 considered significant. Results: In Groups S and D, the mean ages were 39.17 years and 41.5 years, and the percentages of males were 30% and 50%, respectively. The mean times to swallowing, spontaneous eye opening, limb movements, establishing spontaneous regular breathing, responding to verbal commands, extubation, stating a name on command, and achieving a modified Aldrete score ≥9 in minutes were 6.13, 4.87, 5.07, 4.57, 7.40, 8.97, 10.40, and 11.50, respectively. These values were significantly lower in group D. The mean cost per hour and average volume consumption were significantly higher in group D. Conclusion: The study concludes that desflurane provides faster and better recovery from anaesthesia. Although the total cost of desflurane was higher compared to sevoflurane, its use can be beneficial for faster emergence, early transfer from the Post Anaesthesia Care Unit (PACU), and earlier discharge from the hospital.