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Up to date in inhalation anaesthesia: desflurane
BMC Geriatrics volume 10, Article number: A101 (2010)
Inhaled volatile anaesthetics remain the most widely used drugs for maintenance of general anaesthesia because of their ease of administration and predictable intraoperative and recovery characteristics. The result has been an increasing reliance on fluorinated anesthetics. The most recently introduced anesthetics, desflurane and sevoflurane, are ethers halogenated solely with fluorine.
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.
Materials and methods
We randomized 90 outpatients undergoing superficial surgical procedures (umbilical or inguinal hernia repair) 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%–4% in an air/oxygen mixture. The inspired concentration of the volatile anesthetic was varied to maintain hemodynamic stability and a Bispectral Index value of 40–60. Analgesia was provided with local anesthetic infiltration and ketorolac (30 mg IV). Antiemetic prophylaxis consisted of administration of tropisetron 5 mg at the end of surgery. Assessments included recovery times to eye opening, response to commands, orientation, Aldrete and Aldrete modified score. Patient satisfaction with anesthesia, the ability to resume normal activities on the first postoperative day, adverse side effects, 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. Emergence from anesthesia was more rapid after desflurane; however, all patients achieved fast-track recovery criteria before leaving the operating room. Finally, the time to discharge home and the percentage of patients able to resume normal activities on the first postoperative day did not differ significantly between the two anesthetic groups.
Use of desflurane for maintenance of anesthesia was associated with a faster emergence. 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 useful for ambulatory anesthesia.
White Paul, et al: Desflurane Versus Sevoflurane for Maintenance of Outpatient Anesthesia: The Effect on Early Versus Late Recovery and Perioperative Coughing. Anesth Analg. 2009, 109: 387-393. 10.1213/ane.0b013e3181adc21a.
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Corcione, A., Di Dato, M.T. Up to date in inhalation anaesthesia: desflurane. BMC Geriatr 10, A101 (2010). https://doi.org/10.1186/1471-2318-10-S1-A101
- Inguinal Hernia
- Inguinal Hernia Repair
- Laryngeal Mask Airway