Recovery from general anaesthesia in the elderly patient: sevoflurane vs propofol
© Bastianini et al; licensee BioMed Central Ltd. 2011
Published: 24 August 2011
Slower drug metabolism
Decrease in TBW
Increase in LBM/FBM
Decrease in kidney function
This leads to the need to use short half-life drugs, to prevent drug stacking phenomena. Both sevoflurane and propofol meet these requirements.
Materials and methods
This study compares recovery times from general anaesthesia between the selected drugs in patients over 65yo who underwent surgery.
In 3 months 41 patients were selected, similar in age (65-78yo), sex and ASA class, undergoing elective surgery. Patients with lung, liver, kidney, brain and coronaric dysfunctions with ASA III-IV were excluded from the study.
In this single-blind, prospectic study patients were randomized in 2 groups: patients in P-group were treated with propofol (5-8 mg/kg/h), while patients in S-group were treated with sevoflurane (1-2%).
Dosage was managed so that CF and AP wouldn’t shift more than 20% their basal values. All patients were pre-treated with midazolam (0.03mg/kg), fentanyl (1μg/kg) and atropine (up to 0.01ng/kg). Anaesthesia was induced using propofol (2mg/kg) and cisatracurium (0.2mg/kg). Patients were intubated and ventilated using O2 (33%) and N2O (66%). Analgesia during surgery was achieved using fentanyl (1μg/kg) 60min after induction and then using boli every 45min. Parameters monitored for each patient were: AP, CF, ECG, PO2, ET CO2, BIS and diuresis. Times for extubation, recovery room monitoring, eye opening and oriented motory and verbal response were recorded. MMSE was also taken.
Prospectic, randomized study, patients selectedPatients total 41
21 pz. (9M/12F)
20 pz. (10M/10F)
recovery after sevoflurane or propofol suspension
Punch (orientated motory response)
Orientated verbal response
Observation time (min)
Pain score (2 hours after surgery)
Sevoflurane shows the lowest periferic blood solubility and the lowest partition ratio amongst inhaled anaesthetics. This grants both quick induction and recovery. These properties associated with better hemodynamic stability during maintenance of general anaesthesia make this drug favorable for the elderly patient, who often has deficitary cardiac homeostatic mechanisms, both due to advanced age and to other associated diseases.
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