Desflurane Group Research Articles

Comparison of pulmonary mechanics during isoflurane, sevoflurane, and desflurane anesthesia

Background: Practicing anesthesia clinicians are aware that tracheal intubation increases resistance and alters pulmonary mechanics; thus, comparison of bronchodilating effects of volatile agents is desirable. This study was aimed to compare the respiratory mechanics during isoflurane, sevoflurane, and desflurane anesthesia at 1 minimum alveolar concentration (MAC) and 2 MAC. Materials and Methods: Seventy patients undergoing moderate duration surgery were sequentially allocated into one of the three groups: Group I (Isoflurane; n = 23), Group S (Sevoflurane; n = 24), and Group D (Desflurane; n = 23). Peak inspiratory pressure (PIP), dynamic lung compliance (Cdyn), and airway resistance (Raw) values at three different time points were noted: 3 breaths after the start of mechanical ventilation (T1), 5 min after 1 MAC (T2), and 2 min after 2 MAC (T3). Results: PIP increased significantly in the desflurane group by 6% at 1 MAC and 8.06% at 2 MAC from the baseline. Statistically significant increase in Cdyn by 1.59% at 1 MAC and 9.9% at 2 MAC was found in sevoflurane group. Raw decreased significantly by 24.28% at 1 MAC and by 45.65% at 2 MAC from the baseline in sevoflurane group. Conclusions: We conclude that increasing concentrations from 1 MAC to 2 MAC show more consistent bronchodilating effect of Sevoflurane compared to isoflurane and desflurane. Sevoflurane increased Cdyn and reduced Raw from 1 MAC to 2 MAC.

Effects of Total Intravenous Anesthesia and Low- and High-Flow Anesthesia Implementation on Middle Ear Pressure.

Background The middle ear is an air-filled lacuna in the temporal bone. Inhaled anesthetic agents increase the pressure of this lacuna. Therefore, attention must be paid in choosing not only anesthetic agents but also anesthetic method. Aim This study compared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear pressure. Study Design Randomized prospective double-blind study. Methods In this retrospective double-blind study, 90 patients (20–65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow desflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). The hemodynamic and respiratory parameters and tympanometry were measured before induction (T1), 10 minutes after intubation (T2), 10 minutes before the end of the operation (T3), and 5 (T4), 10 (T5), 15 (T6), and 30 (T7) minutes after the operation. Results No statistically significant differences were found in the age, gender, weight, height, body mass index, surgery duration, and anesthetic duration (p > 0.05). There were no statistically significant differences at T1, T3, T4, T5, T6, and T7 (p > 0.007), but there was a significant difference at T2 (p < 0.001), with Groups II and III having lower pressure than Group I (p < 0.001). Conclusion The high-flow desflurane group had higher postinduction middle ear pressure values. Therefore, low-flow anesthesia and TIVA can be used more safely in middle ear surgeries, provided that a well-equipped anesthetic device and appropriate monitoring conditions are available.

Desflurane Attenuates Ventilator-Induced Lung Injury in Rats with Acute Respiratory Distress Syndrome.

Ventilator-induced lung injury aggravates the existing lung injury. This study investigated the effect of desflurane on VILI in a rat model of acute respiratory distress syndrome. Forty-eight rats were randomized into a sham (S) group, control (C) group, lipopolysaccharide/ventilation (LV) group, lipopolysaccharide/ventilation/desflurane (LVD) group, or lipopolysaccharide/low ventilation with and without desflurane (LLV and LLVD) groups. Rats in the S group received anesthesia only. Rats in the LV and LVD groups received lipopolysaccharide and were ventilated with a high tidal volume. Rats in LLV and LLVD groups were treated as the LV and LVD groups and ventilated with a low tidal volume. PaO2/FiO2, lung wet-to-dry weight ratios, concentrations of inflammatory factors in serum and BALF, histopathologic analysis of lung tissue, and levels of nuclear factor- (NF-) κB protein in lung tissue were investigated. PaO2/FiO2 was significantly increased by desflurane. Total cell count, macrophages, and neutrophils in BALF and proinflammatory factors in BALF and serum were significantly decreased by desflurane, while IL-10 was increased. The histopathological changes and levels of NF-κB protein in lung tissue were decreased by desflurane. The results indicated that desflurane ameliorated VILI in a rat model of acute respiratory distress syndrome.

The impact of fresh gas flow on wash-in, wash-out time and gas consumption for sevoflurane and desflurane, comparing two anaesthesia machines, a test-lung study.

Low-flow anaesthesia is considered beneficial for the patient and the environment, and it is cost reducing due to reduced anaesthetic gas consumption. An initial high-flow to saturate the circle system ( wash-in) is desirable from a clinical point of view. We measured the wash-in and wash-out times (time to saturate and to eliminate the anaesthetic agent, AA), for sevoflurane and desflurane, in a test-lung with fixed 3 MAC vaporizer setting at different fresh gas flow (FGF) and calculated the consumption of AA. We tried to find an optimal flow rate for speed and gas consumption, comparing two anaesthesia machines (AMs): Aisys and Flow-i. Time to reach 1 minimal alveolar concentration (MAC) (wash-in) decreased (p&lt;0.05) at higher flow rates (1 – 2 – 4) but plateaued at 4-4.8 l/min. The consumption of AA was at its lowest around 4-4.8 l/min (optimal flow) for all but the Aisys /desflurane group. Wash-out times decreased as FGF increased, until reaching plateau at FGF of 4-6 l/min. Aisys had generally shorter wash-in times at flow rates &lt; 4 l/min as well as lower consumption of AA. At higher flow rates there were little difference between the AMs. The “optimal FGF” for wash-out, elimination of gas from the test-lung and circle system, plateaued with no increase in speed beyond 6 l/min. A fresh gas flow of 4 l/min. seems “optimal” taking speed to reach a 1 MAC ET and gas consumption into account during wash-in with a fixed 3 MAC vaporizer setting, and increasing fresh gas flow beyond 6 l/min does not seem to confirm major benefit during wash-out.

The impact of fresh gas flow on wash-in, wash-out time and gas consumption for sevoflurane and desflurane, comparing two anaesthesia machines, a test-lung study.

Low-flow anaesthesia is considered beneficial for the patient and the environment, and it is cost reducing due to reduced anaesthetic gas consumption. An initial high-flow to saturate the circle system ( wash-in) is desirable from a clinical point of view. We measured the wash-in and wash-out times (time to saturate and to eliminate the anaesthetic agent, AA), for sevoflurane and desflurane, in a test-lung with fixed 3 MAC vaporizer setting at different fresh gas flow (FGF) and calculated the consumption of AA. We tried to find an optimal flow rate for speed and gas consumption, comparing two anaesthesia machines (AMs): Aisys and Flow-i. Time to reach 1 minimal alveolar concentration (MAC) (wash-in) decreased (p<0.05) at higher flow rates (1 – 2 – 4) but plateaued at 4-4.8 l/min. The consumption of AA was at its lowest around 4-4.8 l/min (optimal flow) for all but the Aisys /desflurane group. Wash-out times decreased as FGF increased, until reaching plateau at FGF of 4-6 l/min. Aisys had generally shorter wash-in times at flow rates < 4 l/min as well as lower consumption of AA. At higher flow rates there were little difference between the AMs. The “optimal FGF” for wash-out, elimination of gas from the test-lung and circle system, plateaued with no increase in speed beyond 6 l/min. A fresh gas flow of 4 l/min. seems “optimal” taking speed to reach a 1 MAC ET and gas consumption into account during wash-in with a fixed 3 MAC vaporizer setting, and increasing fresh gas flow beyond 6 l/min does not seem to confirm major benefit during wash-out.

The impact of fresh gas flow on wash-in, wash-out time and gas consumption for sevoflurane and desflurane, comparing two anaesthesia machines, a test-lung study.

Low-flow anaesthesia is considered beneficial for the patient and the environment, and it is cost reducing due to reduced anaesthetic gas consumption. An initial high-flow to saturate the circle system ( wash-in) is desirable from a clinical point of view. We measured the wash-in and wash-out times (time to saturate and to eliminate the anaesthetic agent, AA), for sevoflurane and desflurane, in a test-lung with fixed 3 MAC vaporizer setting at different fresh gas flow (FGF) and calculated the consumption of AA. We tried to find an optimal flow rate for speed and gas consumption, comparing two anaesthesia machines (AMs): Aisys and Flow-i. Time to reach 1 minimal alveolar concentration (MAC) (wash-in) decreased (p<0.05) at higher flow rates (1 - 2 - 4) but plateaued at 4-4.8 l/min. The consumption of AA was at its lowest around 4-4.8 l/min (optimal flow) for all but the Aisys /desflurane group. Wash-out times decreased as FGF increased, until reaching plateau at FGF of 4-6 l/min. Aisys had generally shorter wash-in times at flow rates < 4 l/min as well as lower consumption of AA. At higher flow rates there were little difference between the AMs. The "optimal FGF" for wash-out, elimination of gas from the test-lung and circle system, plateaued with no increase in speed beyond 6 l/min. A fresh gas flow of 4 l/min. seems "optimal" taking speed to reach a 1 MAC ET and gas consumption into account during wash-in with a fixed 3 MAC vaporizer setting, and increasing fresh gas flow beyond 6 l/min does not seem to confirm major benefit during wash-out.

Desflurano versus propofol en la calidad de recuperación de pacientes intervenidos de colecistectomía laparoscópica ambulatoria. Estudio prospectivo, comparativo de no inferioridad

ObjectiveRecently, the evaluation of postoperative results has focused on the opinion of the patient as of great relevance. Our objective was to evaluate the quality of recovery by questionnaire (QoR-15) in patients undergoing laparoscopic cholecystectomy, comparing desflurane versus a total intravenous technique with propofol (TIVA). A non-inferiority hypothesis was proposed between both techniques. Material and methodsProspective longitudinal cohort study in patients undergoing laparoscopic cholecystectomy in which multimodal management was applied including low pneumoperitoneum pressures, deep neuromuscular block and pain prevention strategy and PONV. Anaesthesia maintenance was performed with either desflurane or propofol at the discretion of the anaesthesiologist. QoR-15 was evaluated pre-and 24hours after surgery. ResultsSixty-one patients were evaluated: 29 in the desflurane group and 32 in the TIVA group with no differences in demographic parameters, ASA grade, and preoperative QoR-15 questionnaire. The duration of the intervention was superior in TIVA group, 55 ± 15 vs. 45 ± 9min in desflurane group; p =.05. The desflurane group received more fentanyl than the TIVA group: 200 ± 65 vs. 113 ± 38μg; p =.05. No differences in pain, PONV or time of stay between groups. QoR-15 at 24h decreased 7% relative to baseline, with no differences between groups. ConclusionsThe quality of recovery evaluated by the patient was as favourable in the patients of the desflurane group as in those of the TIVA group in patients undergoing laparoscopic cholecystectomy as outpatients.

Comparison of the Impact on the Extubation Between Desflurane and Sevoflurane in Obese Patients Undergoing Thyroidectomy

Objective: Comparison of the impact on the extubation between desflurane and sevoflurane in obese patients undergoing thyroidectomy. Method: A total number of 60 obesity cases aging between 32~60 were selected, randomly divided into 2 groups, named Desflurane Group (30 cases) and SevofluraneGroup(30cases). Patients were required for anesthesia detection. Penehyclidine 0.5mg. Induction of anesthesia was 1ED95 rocuronium bromide 0.3 mg/kg, midazolam 2mg, propofol 2 mg/kg and sufentanil 0.5 μg/kg.The drugs facilitate tracheal intubation with nerve monitoring function and mechanical ventilation, tidal volume 8~10ml/kg, respiratory rate12/min. Maintained the anesthesia with 1.2~1.4 MAC of desflurane or sevoflurane. Stopping medication after surgery. We recorded the OAA/S scores at 5min, 10min, 20min and 30min later after extubation and Riker agitation sedation scores. SPSS 20.0 software was used to analysis results. Results: Compared with sevoflurane, desflurane has a certain clinical application advantages applying in obese patients with nerve monitoring complexity thyroidectomy, showing short recovery and extubation time obviously. But desflurane showed a higher incidence of postoperative agitation than sevoflurane.

Comparison of Propofol with Desflurane for Laparoscopic Sleeve Gastrectomy in Morbidly Obese patients: A Prospective Randomized Trial

Background: Laparoscopic sleeve gastrectomy has become one of the most effective treatment options for adults with severe obesity. However, optimal anesthetic management for laparoscopic sleeve gastrectomy has not been described yet. Methods: In this prospective randomized study, we compared the effects of propofol anesthesia (Group 1) with desflurane anesthesia (Group II) in morbid obese patients for laparoscopic sleeve gastrectomy. We compared postoperative recovery and hemodynamic parameters of the patients. We also investigated the changes in tracheal cuff pressure and peak airway pressure of these obese patients during orogastric tube insertion and peritoneal CO2 insufflation. Results: Eye opening and extubation time were longer in the propofol group than in the desflurane group (p 0.05). Six patients in Group I and eight patients in Group II had sore throat (p > 0.05). Eight patients in Group I a...

The effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery

Objective To evaluate the effect of desflurane on hemodynamics and myocardial protection in patients undergoing off-pump coronary artery bypass grafting surgery (OPCABG). Methods Fifty patients, scheduled for OPCABG, were randomly assigned to two groups: the desflurane group (D group, n=25) and the propofol group (P group, n=25). For all patients, 10 mg morphine and 3-5 mg midazolam were intramuscularly injected before anesthesia. 0.1-0.2 mg/kg etomidate was used for anesthesia induction followed by rocuronium 0.6 mg/kg and sufentanil 1-2 μg/kg for all patients. For all patients, sufentanil 0.5-1.0 μg/(kg·h) and Cisatr-curium 0.5- 1.0 mg/(kg·h) were maintained. Desflurane 0.7-1.5 MAC was maintained in D group. Propofol 2-8 mg/kg was maintained in P group. Manometry was conducted through puncture in radial artery and right internal jugular vein for all patiens. The changes in cardiac index (CI), heart rate (HR), blood pressure (ABP), right atrial pressure (CVP), pulmonary arterial pressure (PAP) and pulmonary artery wedge pressure (PAWP) were monitored perioperatively. Bispectral index (BIS) was maintained at 40- 60. Temperature and urine were monitorred routinely. Before and 6, 12, 24 and 36 h after operation, blood samples were collected to measure troponin Ⅰ (cTnⅠ) and creatine kinase isoenzyme (CK-MB). Results Plasma cTnⅠ and CK-MB levels in postoperative period were higher than the preoperative baseline in both groups. cTnⅠ and CK-MB level were significantly higher in P group than in D group [(0.77±0.38) vs. (0.96±0.42), P=0.034; (23.79±5.96) vs. (28.13±7.51), P=0.042]. Conclusion Our results suggest that desflurane combined sufentanil anesthesia provides better management of reduced myocardial injury and less intropic agents usage in OPCABG. Key words: Desflurane; Off-pump coronary artery bypass; Hemodynamic; Myocardial protection

The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial

Study objectiveThe goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty. DesignProspective randomized trial. SettingsOperating room, postoperative recovery area, hospital wards. Patients100 obese patients (ASA II and III) undergoing primary total knee replacement under general anesthesia with a femoral nerve block catheter. InterventionPatients were prospectively randomized to maintenance anesthesia with either propofol or desflurane. MeasurementsThe primary endpoint assessed by a blinded investigator was delirium as measured by the Confusion Assessment Method. Secondary endpoints were wake-up times and a battery of six different tests of cognitive function. Main resultsFour of the 100 patients that gave informed consent withdrew from the study. Of the remaining 96 patients, 6 patients did not complete full CAM testing. Preoperative pain scores, durations of surgery and anesthesia, and amount of intraoperative fentanyl were not different between groups. One patient in the propofol group developed delirium compared to zero in desflurane. One patient in desflurane group developed a confused state not characterized as delirium. Fifty percent of the patients exhibited a 20% decrease in the results of at least one cognitive test on the first 2days after surgery, with no difference between groups. There were no differences in the time to emergence from anesthesia, incidence of postoperative nausea and vomiting, and length of postanesthesia care unit (PACU) stay between the two groups. ConclusionsIn conclusion we found a low incidence of delirium but significant cognitive decline in the first 48h after surgery. In this relatively small sample size of a hundred patients there was no difference in the incidence of postoperative delirium, early cognitive outcomes, or wake up times between the desflurane or propofol group.

Effects of sevoflurane and desflurane on pharmacodynamics of rocuronium in children

Objective: To observe the intraoperative influences on pharmacodynamics of rocuronium in children inhaling sevoflurane and desflurane for 40 min balance. Methods: Ninety children (ASAⅠ-Ⅱ) undergoing elective surgery with general anesthesia in Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University from July 2015 to May 2016 were randomly assigned into six groups (n=15): Sevoflurane group (group S1 and S2), Desflurane group (group D1 and D2) and Propofol group (group P1 and P2). Children in group D1, S1 and P1 were allocated to research the dose-effect relationship of rocuronium, children in group D2, S2 and P2 were allocated to research the time-effect relationship of rocuronium. TOF-Watch SX monitor was used to exert a train-of-four stimulation (TOF) at ulnar nerve in wrist, then the adductor pollicis muscle appeared muscle twitch 4 times in turn which was recorded T(1, )T(2, )T(3) and T(4) respectively. After the success of the muscle relaxant calibration, 1.3 MAC sevoflurane and desflurane were inhaled and maintained for 40 min respectively in children in Sevoflurane group (group S1 and S2) and Desflurane group (group D1 and D2), Plasma target controlled infusion of 3.5-4.0 μg/ml propofol was always administered in Propofol group (group P1 and P2). 75 μg/kg rocuronium was injected each time in group S1, D1 and P1 respectively. Maximum inhibited effect of T(1) was recorded after every injection until inhibition of T(1) more than 95% eventually. The method of cumulative dose four times was used to calculate the efficiency curve of rocuronium[median effective dose (ED(50)), 90% effective dose (ED(90)) and 95% effective dose (ED(95))]. 0.6 mg/kg rocuronium was injected respectively through vein in group S2, D2 and P2. The recovery times of muscle relaxant were recorded which including time of T(1) disappeared (onset time), T(1) from 0% to 5% (peak effect time), T(1) from 0% to 25% (clinical effect time), T(1) from 25% to 75% (recovery index), T(1) from 0% to 70% (internal effect time), T(4)/T(1) (TOFr) from 0% to 70% and 90%. Results: ED(50, )ED(90) and ED(95) in group D1 were 128.73, 212.45 and 245.78 μg/kg respectively. ED(50, )ED(90) and ED(95) in group S1 were 132.46, 218.94 and 252.30 μg/kg respectively. ED(50, )ED(90) and ED(95) in group P1 were 230.56, 381.02 and 439.55 μg/kg respectively. ED(50, )ED(90) and ED(95) in group D1 and S1 were significantly lower than those in group P1 (all P<0.05), but there was no significant difference between D1 and S1 group (P>0.05). Compared with group P2, the shorter onset time, the longer peak effect time and clinical effect time was observed in group D2 and S2, the longer recovery index, internal effect time and TOFr from 0% to 70% and 90% was observed in group S2 (all P<0.01). Conclusions: 1.3 MAC sevoflurane and desflurane inhaling for 40 min significantly reduces ED(50) and ED(95) of rocuronium, prolongs the onset time and action time of rocuronium in children. Sevoflurane can significantly prolong the recovery characteristics of rocuronium.

Planning for operating room efficiency and faster anesthesia wake-up time in open major upper abdominal surgery.

Reducing anesthesia-controlled time (ACT) may improve operation room (OR) efficiency result from different anesthetic techniques. However, the information about the difference in ACT between desflurane (DES) anesthesia and propofol-based total intravenous anesthesia (TIVA) techniques for open major upper abdominal surgery under general anesthesia (GA) is not available in the literature.This retrospective study uses our hospital database to analyze the ACT of open major upper abdominal surgery without liver resection after either desflurane/fentanyl-based anesthesia or TIVA via target-controlled infusion with fentanyl/propofol from January 2010 to December 2011. The various time intervals including waiting for anesthesia time, anesthesia time, surgical time, extubation time, exit from OR after extubation, total OR time, and postanesthetic care unit (PACU) stay time and percentage of prolonged extubation (≥15 minutes) were compared between these 2 anesthetic techniques.We included data from 343 patients, with 159 patients receiving TIVA and 184 patients receiving DES. The only significant difference is extubation time, TIVA was faster than the DES group (8.5 ± 3.8 vs 9.4 ± 3.7 minutes; P = 0.04). The factors contributed to prolonged extubation were age, gender, body mass index, DES anesthesia, and anesthesia time.In our hospital, propofol-based TIVA by target-controlled infusion provides faster emergence compared with DES anesthesia; however, it did not improve OR efficiency in open major abdominal surgery. Older, male gender, higher body mass index, DES anesthesia, and lengthy anesthesia time were factors that contribute to extubation time.

Effect of desflurane-remifentanil vs. Propofol-remifentanil anesthesia on arterial oxygenation during one-lung ventilation for thoracoscopic surgery: a prospective randomized trial

BackgroundOne-lung ventilation during thoracic surgery frequently disturbs normal systemic oxygenation. However, the effect of anesthetics on arterial oxygenation during one-lung ventilation has not been well established in human study. In this clinical trial, we investigated whether a difference between desflurane-remifentanil and propofol-remifentanil anesthesia can be observed with regard to oxygenation during one-lung ventilation for thoracoscopic surgery.MethodsAdult patients with lung cancer, scheduled for video-assisted thoracoscopic lobectomy without preoperative oxygen support, were screened and randomized to receive desflurane or propofol, with remifentanil continuous infusion in both groups. Mechanical ventilation was performed with tidal volume of 8 ml/kg and FIO2 0.5 during two-lung ventilation, and 6 ml/kg and 1.0 during one-lung ventilation, both with positive end-expiratory pressure of 5 cmH2O. Arterial blood gas analysis was performed preoperatively, during two-lung ventilation, and after 15, 30, 45, and 60 min of one-lung ventilation. The primary endpoint was PaO2 at 30 min after initiating one-lung ventilation. Statistical analyses included the independent t-test for the primary endpoint and a mixed model with a post-hoc analysis to evaluate the serial changes in values.ResultsPatients were recruited between July 9 and December 2, 2014. In total, 103 patients were analyzed (n = 52 in desflurane group and n = 51 in propofol group). The primary endpoint, PaO2 at 30 min of one-lung ventilation was lower in the desflurane group than the propofol group (170 ± 72 vs. 202 ± 82 mmHg; p = 0.039). Serial changes in PaO2 during one-lung ventilation showed lower levels during desflurane anesthesia compared with propofol anesthesia (mean difference, 45 mmHg; 95% confidence interval, 16–75 mmHg; p = 0.003).ConclusionsIn conclusion, desflurane-remifentanil anesthesia resulted in decreased arterial oxygenation compared with that of propofol-remifentanil anesthesia during one-lung ventilation for thoracoscopic surgery in patients with lung cancer.Trial registrationClinicalTrials.gov identifier: NCT02191371, registered on July 7, 2014

Effects of Devoflurane and Sevoflurane on Cognitive Function in Elderly Patients Undergoing General Anesthesia

Objective: To compare effects of desflurane and sevoflurane on cognitive function in elderly patients undergoing general anesthesia. Methods Eighty elderly patients undergoing general anesthesia under open surgery were enrolled in this study, ASA I ~ II, were divided into group A (desflurane group) and group B (sevoflurane group) randomly. Intravenous drugs included midazolam 0.03 mg / kg, sufentanil 0.5ug / kg, propofol 1-2mg / kg, vecuronium 0.1 mg / kg. All patients were treated with desflurane or sevoflurane to maintain anesthesia, with depth 1.2 ~ 1.4MAC. The mini-mental state examination (MMSE) scores were recorded before operation and 1h, 6h, 12h, 24h and 48h after operation. Results The MMSE scores of the two groups had no significant difference before operation but were significantly lower than those before operation (P <0.05). The MMSE scores of patients in group recovered at 12h after operation(P <0.05). Scores of group B returned in 24h after operation. Scores of group A were higher than group B at 1 h, 6 h and 12 h after operation, the difference was statistically significant. Conclusion The recovery time of cognitive function in elderly desflurane anesthesia patients was significantly less than that of sevoflurane.

Desflurane for ambulatory anaesthesia: A comparison with sevoflurane for recovery profile and airway responses.

Background and Aims:Desflurane and sevoflurane have low blood gas solubility co-efficients, allowing a rapid awakening from anaesthesia. However, desfluraneis pungent and may cause airway irritability. We compared desflurane and sevoflurane with respect to recovery and occurrence of adverse airway responses in spontaneously breathing patients while using the ProSeal™ laryngeal mask airway (LMA).Methods:Ninety-four adult patients undergoing hysteroscopic procedures were divided into sevoflurane (S) group or desflurane (D) group. Patients were premedicated with midazolam 0.03 mg/kg and fentanyl 1μg/kg. Anaesthesia was induced with propofol 2.0–2.5 mg/kg, followed by insertion of a ProSeal™ LMA. Adverse airway responses such as cough, hiccups, laryngospasm and breathholding were recorded. In the post-operative period: time to awakening, response to verbal commands, orientation, ability to sit with support and the recovery room Aldrete score were recorded.Results:Three patients in group S (6.4%) and six patients (13.3%) in Group D had adverse airway events. The mean time to eye opening (Group S-10.75 ± 7.54 min, Group D-4.94 ± 1.74 min), obeying verbal commands (Group S-13.13 ± 8.75 min, Group D-6.55 ± 1.75 min), orientation (Group S-15.42 ± 8.46 min, Group D-6.23 ± 2.4 min) and to sit with support (Group S-36.09 ± 12.68 min, Group D-14.35 ± 3.75 min) were found to be lesser with desflurane than with sevoflurane (P < 0.001). The mean time to recovery was delayed in Group S-46.00 ± 12.86 min compared to Group D-26.44 ± 5.33 min (P < 0.001).Conclusion:Desflurane has faster awakening properties than sevoflurane without an increase in adverse airway events when used during spontaneous ventilation through a ProSeal™ LMA along with propofol and fentanyl.

Comparing incidence of emergence delirium between sevoflurane and desflurane in children following routine otolaryngology procedures

Emergence delirium (ED) is a state of aggressive agitation that can occur temporarily in the process of emerging from anesthesia in children exposed to volatile or intravenous anesthetics. Emergence delirium is typically assessed using the published and validated Pediatric Emergence Delirium (PAED) Scale. Due to some variation in properties between sevoflurane and desflurane for maintenance of anesthesia after standard sevoflurane induction, we designed a prospective study to examine potential differences in emergence behavior and incidence of ED in children undergoing elective ear-nose-throat surgery. Forty-six children aged 12 months-7 years were randomly assigned to receive either sevoflurane (N.=23) or desflurane (N.=23) for maintenance of general anesthesia. All patients were extubated awake in the OR, and upon arrival in the PACU, PAED scores were assessed every 15 minutes until discharged. In addition to PAED scores, time to tracheal extubation, emergence behavior, pain scores, and recovery complications were recorded. We found no significant difference in incidence of ED or peak PAED scores between sevoflurane and desflurane groups (12 [0-18] versus 12 [0-20]; P=0.79). There were no significant differences between desflurane and sevoflurane with respect to incidence of adverse events, such as nausea, vomiting, laryngospasm, or excessive secretions. In conclusion, the use of desflurane for maintenance of anesthesia did not significantly affect the incidence or duration of ED when compared to sevoflurane. However, desflurane did not demonstrate any increase in adverse events, which may support its routine use in this patient population.

The effects of sevoflurane and desflurane on the hemodynamics and respiratory functions in laparoscopic sleeve gastrectomy

Study objectivesSleeve gastrectomy has been one of the most commonly performed bariatric surgery methods. The study aimed to compare the effects of 2 most commonly used inhalation anesthetics, sevoflurane and desflurane, on the peroperative hemodynamic alterations and postoperative respiratory functions in morbidly obese patients undergoing sleeve gastrectomy. DesignNonrandomized cohort. SettingsOperating room, postoperative period. PatientsEighty-four morbidly obese patients with a body mass index greater than 40 kg/m2 who had scheduled to undergo sleeve gastrectomy operation were prospectively included in the study. InterventionsPatients were divided into 2 groups. The maintenance of inhalation anesthesia was performed by sevoflurane in 1 group (sevoflurane group) and desflurane (desflurane group) in the other group. MeasurementsDemographic features, peroperative hemodynamic alterations, and the results of preoperative and postoperative 24th hour respiratory function tests were recorded. ResultsThere was not any statistically significant difference between groups regarding age, sex, body mass index, anesthesia time, peroperative mean arterial pressure, arterial oxygen saturation, end-tidal carbon dioxide, and preoperative or postoperative forced expiratory volume 1/forced vital capacity ratios. ConclusionWe determined that both desflurane and sevoflurane provide similar intraoperative hemodynamic and early postoperative respiratory functions in morbidly obese patients in laparoscopic sleeve gastrectomy. Both agents can be regarded as alternatives for inhalation anesthetics in maintenance of anesthesia.

Retrospective cohort investigation of perioperative upper respiratory events in children undergoing general anesthesia via a supraglottic airway: A comparison of sevoflurane and desflurane.

Desflurane is the most pungent of the currently used volatile anesthetics. We assessed whether the incidence of perioperative upper respiratory events in children undergoing general anesthesia via a supraglottic airway is higher with desflurane than with sevoflurane as maintenance anesthetic.We retrospectively reviewed and analyzed the electronic medical records of consecutive children 1 to 15 years of age who underwent general anesthesia via a supraglottic airway at Seoul National University Bundang Hospital between June 2013 and June 2015. The patients were assigned to the sevoflurane or desflurane group according to the anesthetic used. The characteristics of the patients were compared. The primary outcome variable was the incidence of upper respiratory events.The incidence of upper respiratory events in the 3439 evaluated patients was 0.43% (12/2777) in the sevoflurane group and 0.30% (2/662) in the desflurane group (P = 0.75; odds ratio = 0.69 [95% confidence interval = 0.16–3.13]). The difference between the 2 groups was not significant.Compared with sevoflurane, desflurane does not increase the risk of perioperative upper respiratory events in children receiving general anesthesia via a supraglottic airway.

Effect of day/night administration of three different inhalational anesthetics on melatonin levels in rats

The nocturnal peak of melatonin can be altered after anesthesia and surgery. We aimed to examine the melatonin levels during the day and night after anesthesia with three commonly used inhalational anesthetics. Forty-eight male Wistar albino rats were randomized into eight groups. Rats were administered anesthesia between 7:00 am and 1:00 pm (day groups) or 7:00 pm and 1:00 am (night groups) for 6 hours. At the end of the anesthesia, blood samples were collected for assessing melatonin levels. Mean values of melatonin levels after 6 hours of anesthesia during daytime were 43.17±12.95 for control, 59.79±27.83 for isoflurane, 50.75±34.28 for sevoflurane and 212.20±49.56 pg/mL for desflurane groups. The night groups’ mean melatonin levels were 136.12±33.20 for control, 139.85±56.29 for isoflurane, 117.48±82.39 for sevoflurane and 128.70±44.63 pg/mL for desflurane groups. Desflurane anesthesia between 7:00 am and 1:00 pm significantly increased melatonin levels (p<0.001). Sevoflurane and desflurane anesthesia between 7:00 pm and 1:00 am decreased the melatonin levels but there were no significant differences (p=0.904 and p>0.99, respectively). Isoflurane anesthesia did not significantly change melatonin levels during day or night (p=0.718 and p>0.99, respectively). Our results demonstrate that during daytime desflurane anesthesia can alter melatonin levels. Altered melatonin rhythm following inhalational anesthesia can be related to sleep disorders observed after anesthesia.