Standard anesthetic technique for middle ear surgical procedures: A comparison of desflurane and sevoflurane

Abstract

Objectives: Otologic microsurgery requires a bloodless, motionless operative field, rapid awakening, and a reduced incidence of postoperative morbidities especially nausea and vomiting (PONV). This study assesses perioperative outcomes using Desflurane (DES) or Sevoflurane (SEVO) anesthesia for middle ear microsurgery. Methods: A total of 100 healthy adult patients undergoing otologic surgery were randomly assigned to receive SEVO or DES. Propofol 2mg/kg, Fentanyl 2mcg/kg, and Atracurium 0.5mg/kg was used to induce anesthesia and DES 6%-9% ET (group 1) or SEVO 2%-3% ET (group 2) was used for maintenance. Anesthetic depth was titrated by BIS. All surgical and anesthesia times were recorded as well as all intraoperative hemodynamic variables. Pain and nausea scores, discharge readiness, frequency of anti-emetic medication and satisfaction scores were also recorded with appropriate statistical comparisons made between group. Results: Groups were similar as were surgical and emergence times. No hemodynamic differences were noted but BIS numbers tended to be lower in the DES group. Postoperative MAP was higher with DES but no differences were noted with PONV, pain, or discharge readiness. Patients with PONV had lower BIS scores than average but DES patients had the lowest BIS scores. Costs for DES anesthesia were higher than SEVO. Conclusions: Patients given SEVO required less anesthetic depth to maintain ideal intraoperative conditions and had better postoperative hemodynamics compared to DES. Patients with PONV had lower BIS scores than patients without nausea suggesting deeper anesthetic levels are associated with PONV. Though postoperative outcomes were similar, DES anesthesia was more expensive SEVO may offer more advantages for otologic microsurgery.