Desflurane Group Research Articles

Meta-analysis of desflurane and propofol average times and variability in times to extubation and following commands

We performed a meta-analysis to compare the operating room recovery time of desflurane with that of propofol. Studies were included in which a) humans were assigned randomly to propofol or desflurane groups without other differences between groups (e.g., induction drugs) and b) mean and standard deviation were reported for extubation time and/or time to follow commands. Since there was heterogeneity of variance between treatment groups inthe log-scale (i.e., unequal coefficients of variation of observations in the time scale), generalized pivotal methods for the lognormal distribution were used as inputs of the random effects meta-analyses. Desflurane reduced the variability (i.e., standard deviation) intime to extubation by 26% relative topropofol (95% confidence interval [CI], 6% to 42%; P=0.006) and reduced the variability in time tofollow commands by 39% (95% CI, 25% to 51%; P<0.001). Desflurane reduced the mean time to extubation by 21% (95%CI, 9% to 32%; P=0.001) and reduced the mean time tofollow commands by 23% (95% CI, 16% to 30%; P<0.001). The mean reduction in operating room recovery time for desflurane relative topropofol was comparable with that shown previously for desflurane relative to sevoflurane. The reduction in variability exceeded that of sevoflurane. Facilities can use the percentage differences when making evidence-based pharmacoeconomic decisions.

The effects of desflurane and sevoflurane on the peri- and postoperative bleeding of adenotonsillectomy patients

Objective To compare the effects of, volatile anesthetics, desflurane and sevoflurane on intra-operative and postoperative bleeding in patients who underwent tonsillectomy and adenoidectomy. Material and method Totally 40 children (14 girl and 26 boys) aged between 2 and 16 years were included in this prospective randomized double-blind clinical trial. The patients underwent conventional cold tonsillectomy and curettage adenoidectomy under general anesthesia. For the maintenance of anesthesia, the patients were randomized into two groups; desflurane group and sevoflurane group, each including 20 subjects. Desflurane concentration was set between 4% and 6% (0.7–0.9 MAC), whereas sevoflurane concentration was set between 2% and 2.5% (0.7–0.9 MAC). The amount of perioperative bleeding in milliliters was measured by using separate aspirator bags for each patient. Results Desflurane caused significantly lower amount of perioperative bleeding compared to sevoflurane ( p = 0.03). No significant difference was observed between the two groups in terms of age, body mass index and operation duration, respectively ( p = 0.20, p = 0.49, p = 0.07). Conclusion Desflurane, which is one of the volatile anesthetics, leads to a lower amount of intraoperative bleeding than sevoflurane during tonsillectomy and adenoidectomy operations.

Does intraoperative remifentanil infusion really make more postoperative pain?

Does intraoperative remifentanil infusion really make more postoperative pain?

Effects of sevoflurane,isoflurane and desflurane on transcranial electrical motor evoked potentials in patients undergoing neurosurgery

Objective To compare the effects of sevoflurane,isoflurane and desflurane on transcranial electrical motor evoked potentials(MEPs)in patients undergoing neurosurgery.Methods Sixty ASA Ⅰ or Ⅱ patients aged 18-64 yr undergoing neurosurgery were randomly divided into 3 groups(n = 20 each): sevoflurane group,isoflurane group and desflurane group.BIS value and MEPs were monitored.The end-tidal concentrations of sevoflurane,isoflurane and desflurane were adjusted and maintained at 0.50,0.75,1.00 and 1.30 MAC respectively for at least 15 min during 6 stimuli delivered at 1000 Hz and 300 V lasting for 75 μs.The amplitudes and latency of MEPs and BIS value were recorded before administration(baseline)and the each stable state (T1-4).The failure rate of MEPs was also recorded.Results The amplitude of MEPs and BIS value were significantly decreased at T1.2 and the latency of MEPs was prolonged at T1-4 in desflurane group compared with sevoflurane and isoflurane groups(P＜0.05).There was no significant difference in the amplitudes and latency of MEPs and BIS value between group sevoflurane and isoflurane(P＞0.05).The failure rates of MEPs were 0 at baseline,T1 and T2,0,5% and 20% at T3 ,and 5%,20% and 45% at T4 in sevoflurane,isoflurane and desflurane groups respectively.The failure rate of MEPs was significantly higher in desflurane group than in sevoflurane and isoflurane groups(P＜0.05).Conclusion Desflurane has greater suppressive effect on MEPs than sevoflurane and isoflurane.1.00 MAC of sevoflurane and isoflurane,while 0.75-1.00 MAC of desflurane may be the suitable end-tidal concentration for MEP monitoring. Key words: Anesthetics,inhalation; Isoflurane; Evoked potentials,motor; Electric stimulation

Time in General Anesthesia: Depriving the Homeostat?

Time in General Anesthesia: Depriving the Homeostat?

The effects of changing from isoflurane to desflurane on the recovery profile during the latter part of anesthesia.

It is not known whether changing from isoflurane to desflurane during the latter part of anesthesia shows early emergence and recovery in long surgery. We therefore evaluated the effects of changing isoflurane to desflurane on emergence and recovery. Eighty-two patients were randomly assigned to receive isoflurane (Group I) or desflurane (Group D) or to change from isoflurane to desflurane anesthesia (Group X). At the point when there was an hour until the operation would end, isoflurane was replaced with 1 MAC of desflurane in Group X, and isoflurane and desflurane were maintained at 1 MAC in Groups I and D. When the operation ended, we compared the emergence and recovery characteristics among the 3 groups. Compared with Group I, Group X showed faster emergence and recovery. Group X and Group D showed similar emergence and recovery. In conclusion, changing isoflurane to desflurane during the latter part of anesthesia improves emergence and recovery.

Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery

To lower the incidence and severity of fetal cardiovascular depression during maternal fetal surgery under general anesthesia. We hypothesized that supplemental intravenous anesthesia (SIVA) with propofol and remifentanil would lower the need for high-dose inhalational anesthesia and provide adequate maternal depth of anesthesia and uterine relaxation. SIVA technique would minimize prolonged fetal exposure to deep inhalational anesthetics and significant intraoperative fetal cardiovascular depression. Fetal hypoxia and significant fetal hemodynamic changes occur during open fetal surgery because of the challenges such as surgical manipulation, hysterotomy, uterine contractions, and effects of anesthetic drugs. Tocolysis, a vital component of fetal surgery, is usually achieved using volatile anesthetic agents. High concentrations of volatile agents required to provide an appropriate degree of uterine relaxation may cause maternal hypotension and placental hypoperfusion, as well as direct fetal cardiovascular depression. We reviewed medical records of 39 patients who presented for ex utero intrapartum treatment and mid-gestation open fetal surgery between April 2004 and March 2009. Out of 39 patients, three were excluded because of the lack of echocardiographic data; 18 patients received high-concentration desflurane anesthesia and 18 patients had SIVA with desflurane for uterine relaxation. We analyzed the following data: demographics, fetal medical condition, anesthetic drugs, concentration and duration of desflurane, maternal arterial blood pressure, intraoperative fetal echocardiogram, presence of fetal bradycardia, and need for intraoperative fetal resuscitation. Adequate uterine relaxation was achieved with about 1.5 MAC of desflurane in the SIVA group compared to about 2.5 MAC in the desflurane only anesthesia group (P = 0.0001). More fetuses in the high-dose desflurane group compared to the SIVA group developed moderate-severe left ventricular systolic dysfunction over time intraoperatively (P = 0.02). 61% of fetuses in the high-dose desflurane group received fetal resuscitative interventions compared to 26% of fetuses in the SIVA group (P = 0.0489). SIVA as described provides adequate maternal anesthesia and uterine relaxation, and it allows for decreased use of desflurane during open fetal surgery. Decreased use of desflurane may better preserve fetal cardiac function.

Meta-Analysis of Average and Variability of Time to Extubation Comparing Isoflurane with Desflurane or Isoflurane with Sevoflurane

We recently determined how to use anesthesia information management system data to model the time from end of surgery to extubation. We applied that knowledge for meta-analyses of trials comparing extubation times after maintenance with desflurane and sevoflurane. In this study, we repeated the meta-analyses to compare isoflurane with desflurane and sevoflurane. A Medline search through December 2009 was used to identify studies with (1) humans randomly assigned to isoflurane or desflurane groups without other differences (e.g., induction drugs) between groups, and (2) mean and SD reported for extubation time and/or time to follow commands. The search was repeated for random assignment to isoflurane or sevoflurane groups. We considered extubation times >15 minutes (representing 15% of cases in the anesthesia information management system data) to be prolonged. Desflurane reduced the mean extubation time by 34% and reduced the variability in extubation time by 36% relative to isoflurane. These reductions would reduce the incidence of prolonged extubation times by 95% and 97%, respectively. Sevoflurane reduced the mean extubation time by 13% and reduced the SD by 8.7% relative to isoflurane. These reductions would reduce the incidence of prolonged extubation times by 51% and 35%, respectively. The pharmacoeconomics of volatile anesthetics are highly sensitive to measurement of relatively small time differences. Therefore, surgical facilities should use these values combined with their local data (e.g., mean baseline extubation times) when making evidence-based management decisions regarding pharmaceutical purchases and usage guidelines.

Comparison of the effect of sevoflurane and desflurane on postoperative arrhythmia and QT dispersion

Abstract The aim of this study was to investigate the effect of sevoflurane and desflurane on cardiac arrhythmias in adult patients who will be anesthetized. A total of 40 patients who were in the ASA I–II group and who were to undergo elective surgery were included in the study. No pre-medication was administered to the patients. They were monitored with the Holter equipment at preoperative 24 hours, and also at postoperative 24 hours on condition that Holter monitoring will begin before induction. Following routine monitoring, the patients were randomly divided into two equal groups; group one was given sevoflurane and group two was given desflurane. In this study, desflurane and sevoflurane resulted in both a significant prolongation of QT and QTc and a significant increase in QT and QTc dispersion when compared with the basal values. In the sevoflurane group, there was no significant increase in postoperative ventricular arrhythmia, compared to that during the preoperative period. However, this increase was significant in the desflurane group (p = 0.009). Sevoflurane and desflurane result in an increase in QT dispersion. Postoperative rhythmic control should carefully be monitored, especially in the desflurane group.

Desflurane Versus Sevoflurane to Reduce Blood Loss in Maxillofacial Surgery

In our study, desflurane was hypothesized to reduce blood loss more than sevoflurane, both used with targeted mild controlled hypotension. A total of 20 American Society of Anesthesiologists Class I patients undergoing maxillofacial elective surgery for maxillary and mandibular osteotomies were randomized to a desflurane group or a sevoflurane group. Anesthesia was performed with an end tidal value of the inhaled agent to obtain a bispectral index value <30 but without burst-suppression patterns (minimal alveolar concentration age-corrected between 0.7 and 0.9). Remifentanil was administered at a dose of 0.5 microg x kg(-1) x min(-1) to obtain analgesia and a <2 surgical field level in Fromme's modified scale. Sodium-nitroprusside was administered on demand to have a surgical field level of <2 when the anesthesia plan was not sufficient to achieve this target. The minimal value of the mean arterial pressure achievable was 60 mm Hg. In the desflurane group, blood loss was more restricted. The hypotensive drug was used in 8 patients in the sevoflurane group and 2 patients in the desflurane group. Anesthesia with desflurane can reduce blood loss and could give an acceptable surgical field with mild controlled hypotension and with a substantial reduction in the vasoactive drug requirement. These data need to be assessed with an enlargement of the statistical sample.

Effect of desflurane at less than 1 MAC on QT interval prolongation induced by tracheal intubation

Desflurane at more than 1 minimum alveolar concentration (MAC) has been shown to prolong the QT interval, but it is unclear whether this is the case at lower concentrations. The aim of this study was to determine whether desflurane concentrations of <1 MAC affect tracheal intubation-induced prolongation of the QT interval. Forty-four subjects received either inspired desflurane at 1 MAC in oxygen 100% at a fresh gas flow rate of 6 litre min(-1) (desflurane group) or only oxygen 100% (control group) beginning at anaesthesia induction with propofol, before tracheal intubation. The QT intervals were corrected by Bazett's (QTcB) and Fridericia's (QTcF) formulae. The primary outcome was the QTcB immediately after tracheal intubation. Secondary outcomes were the interval from the peak to the end of the T wave (Tp-e), mean arterial pressure (MAP), heart rate (HR), and bispectral index (BIS) score. The QTc interval immediately after tracheal intubation did not differ between the control and the desflurane groups [QTcB, 451 (sd 23) vs 456 (27) ms, P=0.56; QTcF, 422 (24) vs 429 (22) ms, P=0.31, control vs desflurane group, respectively]. There was no difference in Tp-e or HR between the two groups in this study. However, MAP and the BIS score were significantly lower in the desflurane group until 1 min after tracheal intubation. The administration of desflurane at an inspiratory concentration of 1 MAC during manually controlled ventilation after anaesthesia induction with propofol did not affect tracheal intubation-induced QTc prolongation.

Comparison of early cognitive function and recovery after desflurane or sevoflurane anaesthesia in the elderly: a double-blinded randomized controlled trial

Postoperative cognitive dysfunction (POCD) is being recognized as a complication contributing to perioperative morbidity and mortality of the elderly. We hypothesized that the use of the shorter-acting volatile anaesthetic desflurane would be associated with less incidence of POCD when compared with sevoflurane. Approved by the local ethical committee, 80 patients (aged 65-75 yr) were enrolled in this randomized, double-blinded study. Patients were allocated to either the desflurane (n=40) or the sevoflurane (n=40) group. The primary outcome was the cognitive Test for Attentional Performance with its subtests Alertness, Divided Attention, Visual Scanning, Working Memory, and Reaction Change. In addition, Paper-Pencil Tests [Well-being Test BF-S, Recall of Digit Span (DST), Digit-Symbol-Substitution Test, Trail Making Tests A and B, and Spielberg State-Trait Anxiety Inventory] were measured. After baseline assessment 12-24 h before operation, patients were followed up 6-8 and 66-72 h after operation. Among other outcome parameters, emergence times from anaesthesia and modified Aldrete scores were recorded. There was no difference in the incidence of POCD. However, according to the Paper-Pencil Tests, significant improvements for the desflurane group could be detected (Well-being Test at 6-8 h, DST at 6-8 h, and Trail Making Test at 66-72 h). Emergence was significantly faster in the desflurane group for 'time to open eyes' and 'time to extubation'. The total incidence of POCD showed no differences between the desflurane and the sevoflurane groups. However, the tests Well-being scale, DST, and Trail Making Test, emergence times, and patients' satisfaction were in favour of desflurane.

Comparación de la incidencia de tos entre desflurano y sevoflurano cuando se utiliza la máscara laríngea. Ensayo clínico controlado

To determine the incidence of cough with the administration of desflurane and sevoflurane through a laryngeal mask. A double-blind controlled clinical trial in 90 patients who received general anesthesia for ear, nose and throat surgery outpatient. The experimental group (n = 45) inhaled desflurane and the control group (n = 45) inhaled sevoflurane. Rugloop simulation software was used to assure that each patient was under the effect of the induction agent (propofol). The Gasman program was used to ascertain that a minimum alveolar concentration of 1 had been achieved before the hypnotic effect of propofol was lost. Cough was evaluated on the Shahbaz scale during the 10 minutes following induction and at the end of the procedure. Cough in the first 10 minutes was recorded in 53.6% of patients in the desflurane group and in 2.4% in the sevoflurane group (P < .05). Between-group differences were also evident at the end of surgery (desflurane group, 24%; sevoflurane group, 9.7%; P< .05). The patients who inhaled desflurane through a laryngeal mask had a higher incidence of cough than those who inhaled sevoflurane. The mechanism by which cough is being triggered by desflurane should be studied to determine whether the effect is chemical or mechanical and whether it is acting in the larynx or in the distal portion of the lung.

Echocardiographic evaluation and comparison of the effects of isoflurane, sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction

This prospective randomized study aims to evaluate and compare the effects of isoflurane, sevoflurane and desflurane (study drugs) on left ventricular (LV) diastolic function in patients with impaired LV relaxation due to ischemic heart disease using transesophageal Doppler echocardiography. After approval of the local ethics committee and informed consent, 45 patients scheduled for coronary artery bypass grafting surgery were enrolled in the study. Patients were selected by a preoperative Transthoracic Echocardiographic diagnosis of impaired relaxation or Grade 1 Diastolic Dysfunction. They randomly received fentanyl and midazolam anesthesia with 1 MAC of isoflurane (n=16), sevoflurane (n=14) or desflurane (n=15). Hemodynamic parameters and TEE derived ventricular diastolic relaxation indices before and after the study drug administration were compared. LV filling pressures were kept constant throughout the study period to exclude the effect of the loading conditions on diastolic function. Four patients in the sevoflurane group and three in the desflurane group were excluded from the study, after baseline TEE examination revealed normal diastolic filling pattern. All the three study drugs significantly reduced the systemic vascular resistance index with a significant increase in cardiac index. Mean arterial pressure was reduced by all the drugs, although the decrease was not statistically significant. Hemodynamic changes were comparable between all the three groups. In terms of LV relaxation indices, all three agents led to a significant improvement in diastolic function. Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly accompanied by a significant decrease in deceleration time and isovolumetric relaxation time. The effect of all three agents on diastolic relaxation parameters was comparable. In conclusion , Isoflurane, sevoflurane and desflurane, do not appear to have a detrimental effect in patients with early diastolic dysfunction. On the contrary, these inhalational agents actually improve the LV relaxation. A significant reduction in afterload produced by these vapors can be a possible reason for these findings. The positive effect of these inhalational agents on LV relaxation can have a profound effect on the perioperative anesthetic management of patients with diastolic dysfunction.

Comparison of recovery from anesthesia with isoflurane, sevoflurane, or desflurane in healthy dogs

To determine the quality and speed of recovery from anesthesia with isoflurane, sevoflurane, or desflurane and determine end-tidal inhalant concentration at certain events during recovery in healthy dogs. 11 healthy dogs. Anesthesia was induced with propofol (IV), and dogs were assigned by use of a crossover design to receive isoflurane at 2.0%, sevoflurane at 3.2%, or desflurane at 11% end-tidal concentrations. Direct blood pressure was monitored throughout the 120 minutes of anesthesia. At the end of anesthesia, the circuit was flushed with oxygen, and the time to specific events in recovery and overall quality of recovery were assessed. Blood gas concentrations were measured prior to anesthesia and after recovery. Dogs in the desflurane group had the shortest time to standing (11.7 +/- 5.1 minutes), followed by dogs in the sevoflurane group (18.6 +/- 7.5 minutes) and dogs in the isoflurane group (26.3 +/- 7.2 minutes). There was no difference for recovery quality among groups. Arterial blood pressure was higher in the sevoflurane group than in the desflurane group at 10 and 15 minutes and in the isoflurane group at 10, 15, 30, 45, 60, 75, 105, and 120 minutes. There were no significant differences among groups with respect to blood gas concentrations. Results suggested that in dogs for which a short interval to standing is desired, desflurane is the best selection, followed by sevoflurane.

A comparison of volatile and non volatile agents for cardioprotection during on‐pump coronary surgery

A randomised study of 414 patients undergoing coronary artery surgery with cardiopulmonary bypass was conducted to compare the effects of a volatile anaesthetic regimen with either deesflurane or sevoflurane, and a total intravenous anaesthesia (TIVA) regimen on postoperative troponin T release. The primary outcome variable was postoperative troponin T release, secondary outcome variables were hospital length of stay and 1-year mortality. Maximal postoperative troponin T values did not differ between groups (TIVA: 0.30 [0.00-4.79] ng x ml(-1) (median [range]), sevoflurane: 0.33 [0.02-3.68] ng x ml(-1), and desflurane: 0.39 [0.08-3.74] ng x ml(-1)). The independent predictors of hospital length of stay were the EuroSCORE (p < 0.001), female gender (p = 0.042) and the group assignment (p < 0.001). The one-year mortality was 12.3% in the TIVA group, 3.3% in the sevoflurane group, and 6.7% in the desflurane group. The EuroSCORE (p = 0.003) was the only significant independent predictor of 1-year mortality.

Desflurane Versus Sevoflurane for Maintenance of Outpatient Anesthesia: The Effect on Early Versus Late Recovery and Perioperative Coughing

There is controversy regarding the relative perioperative benefits of desflurane versus sevoflurane when used for maintenance of anesthesia in the ambulatory setting. Although studies have consistently demonstrated a faster emergence with desflurane (versus sevoflurane), the impact of this difference on the later recovery end points has not been definitively established. Furthermore, the effect of desflurane (versus sevoflurane) on the incidence of coughing is also controversial. We randomized 130 outpatients undergoing superficial surgical procedures requiring general anesthesia to one of two maintenance anesthetic treatment groups. All patients were induced with propofol, 2 mg/kg IV, and after placement of a laryngeal mask airway, anesthesia was maintained with either sevoflurane 1%-3% or desflurane 3%-8% in an air/oxygen mixture. The inspired concentration of the volatile anesthetic was varied to maintain hemodynamic stability and a Bispectral Index value of 50-60. Analgesia was provided with local anesthetic infiltration and ketorolac (30 mg IV). Antiemetic prophylaxis consisted of a combination of ondansetron (4 mg), dexamethasone (4 mg), and metoclopramide (10 mg) at the end of surgery. Assessments included recovery times to eye opening, response to commands, orientation, fast-track score of 14, first oral intake, sitting, standing, ambulating unassisted, and actual discharge. Patient satisfaction with anesthesia, the ability to resume normal activities on the first postoperative day, adverse side effects (e.g., coughing, purposeful movement, oxygen desaturation <90%, sore throat, postoperative nausea, and vomiting), and the requirement for postoperative analgesic and antiemetic drugs were recorded in the early postoperative period and during the initial 24-h period after discharge. The two study groups had comparable demographic characteristics. Although the overall incidence of coughing during the perioperative period was higher in the desflurane group (60% versus 32% in the sevoflurane group, P < 0.05), the incidences of coughing during the actual administration of the volatile anesthetics (i.e., the maintenance period) did not differ between the two groups. Emergence from anesthesia was more rapid after desflurane; however, all patients achieved fast-track recovery criteria (fast-track score >or=12) before leaving the operating room. Finally, the time to discharge home (90 +/- 31 min in sevoflurane and 98 +/- 35 min in desflurane, respectively) and the percentage of patients able to resume normal activities on the first postoperative day (sevoflurane 48% and desflurane 60%) did not differ significantly between the two anesthetic groups. Use of desflurane for maintenance of anesthesia was associated with a faster emergence and a higher incidence of coughing. Despite the faster initial recovery with desflurane, no significant differences were found between the two volatile anesthetics in the later recovery period. Both volatile anesthetics should be available for ambulatory anesthesia.

Facial Nerve Electromyographic Monitoring to Predict Movement in Patients Titrated to a Standard Anesthetic Depth

Facial nerve (FN) monitoring has been accepted as a standard of care in craniofacial, middle ear, and skull-based surgeries as a means of reducing iatrogenic injury, localizing the FN, and predicting postoperative neurologic function. Past studies have also shown that FN electromyographic monitoring (FNEMG) may have some clinical utility as a monitor of anesthetic depth and predicting patient movement. In this study, we evaluated Bispectral Index (BIS) and FNEMG using two different anesthetic techniques to determine whether these monitors can be used to predict movement in patients undergoing skull-based surgical procedures. Using a single-blinded, randomized, controlled clinical trial, the relationship between FNEMG monitoring and BIS to predict movement during specific craniofacial and skull-based surgeries performed under general anesthesia was evaluated. In addition, a total IV anesthetic (TIVA) technique, using propofol and remifentanil, was compared with an inhaled anesthetic technique, using desflurane (DES), to determine which regimen provides the best conditions of adequate anesthesia and prevents movement in nonparalyzed patients undergoing a surgical procedure requiring FNEMG monitoring. The TIVA technique produced better hemodynamic conditions compared with DES. No significant differences were noted in BIS values between the two groups. However, FNEMG activity was lower in the TIVA group during emergence from the effects of anesthesia. More patients moved during anesthesia with DES compared with TIVA, and of the 10 patients who moved, eight had significant FNEMG activity. The positive predictive value of the FNEMG for movement was found to be 38%, and the negative predictive value was 95%. There was no significant change from baseline values in hemodynamics or BIS value for patients who experienced movement compared with those who did not move with FNEMG activity. This study shows that FNEMG may be an effective monitor for predicting patient movement when undergoing craniofacial and skull-based surgeries. BIS monitoring, however, was not an adequate monitor to predict movement in this patient population. The DES group had more hemodynamic variability and FNEMG activity, whereas TIVA proved to be a more effective anesthetic in preventing patient movement when clinically titrated to produce stable operation conditions. FNEMG was a useful clinical tool to help predict and prevent movement in these patients.

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study

Background: Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. Objective: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. Methods: Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2–2.5 mg/kg) and alfentanil (20 μg/kg) or desflurane (4%–6%) and alfentanil (20 μg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. Results: Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). Conclusion: Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.

The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video‐assisted thoracoscopic‐extended thymectomy

Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video-assisted thoracoscopic-extended thymectomy (VATET). Thirty-six MG patients who underwent VATET were enrolled. Nineteen patients were anesthetized with remifentanil and propofol infused with a target-controlled infusion plasma model, and 17 patients with desflurane and remifentanil. No muscle relaxant was used. The intubating conditions, hemodynamic and respiratory changes, neuromuscular transmission and post-operative complications were evaluated. Neuromuscular transmission was significantly decreased in the desflurane group (6.7%, from 3% to 9% during anesthesia P=or<0.05). The intubating conditions were good in all 36 patients and 35 patients were successfully extubated in the operating room. The time-to-awakening, post-operatory pH and base excess were significantly different in the two groups, with a decreasing mean arterial pressure in the group administered with desflurane. No patients required reintubation due to myasthenic or cholinergic crisis, or respiratory failure. No other significant differences between the two groups studied were observed. Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post-operative complications in the two groups.