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BJA Advance Access originally published online on July 9, 2007
British Journal of Anaesthesia 2007 99(3):353-358; doi:10.1093/bja/aem197
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Faster wash-out and recovery for desflurane vs sevoflurane in morbidly obese patients when no premedication is used

L. La Colla1,*, A. Albertin1, G. La Colla3 and A. Mangano2

1 Department of Anesthesiology
2 Department of Plastic and Reconstructive Surgery, Vita-Salute San Raffaele University School of Medicine, IRCCS San Raffaele, Via Olgettina 60, 20132 Milan, Italy
3 Department of Anesthesiology, University of Modena and Reggio Emilia, Modena, Italy

* Corresponding author. E-mail: l.lacolla{at}studenti.hsr.it

Background: The aim of this study was to compare desflurane vs sevoflurane kinetics and dynamics in morbidly obese patients and their recovery profile when no premedication had been used.

Methods: Twenty-eight unpremedicated obese patients were randomly allocated to receive either sevoflurane (n = 14) or desflurane (n = 14) as the main anaesthetic agent. After induction of anaesthesia, either sevoflurane 2% or desflurane 6% was administered for 30 min via a non-rebreathing circuit. The kinetics of sevoflurane and desflurane were determined by measuring and recording end-tidal samples during this time. The bispectral index was used to indicate the level of hypnosis. At the end of the procedure, the end-tidal concentrations of sevoflurane and desflurane were recorded during the first 5 min after stopping their administration. Time from discontinuation of the anaesthetic drugs to eye opening on verbal command, squeezing the observer's hand on command, extubation, stating their name, giving their correct date of birth, discharge from the recovery room, and duration of the surgery and anaesthesia were also recorded.

Results: The FA/FI ratio was significantly higher in the desflurane group from the 15th to the 30th min. The wash-out phase was faster for desflurane during the total observation period. When desflurane was used, recovery was also faster.

Conclusions: Desflurane provides faster wash-in and wash-out than sevoflurane in morbidly obese patients, and recovery is much faster after desflurane administration when no premedication has been used.

Keywords: anaesthetic techniques, inhalation; anaesthetics volatile, desflurane; anaesthetics volatile, sevaflurane; pharmacokinetics, obesity


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