British Journal of Anaesthesia, 2003, Vol. 91, No. 4 502-506
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia
1 Department of Anesthesiology, 2 Department of Physiology and 3 Department of Pharmacology, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
Corresponding author. E-mail: james.heavner@ttmc.ttuhsc.edu 
Declaration of interest: This lab has participated in several studies sponsored by Baxter Healthcare, the sponsor of the study reported in this manuscript. Dr Alan Kaye is a paid speaker on Baxter’s speakers bureau.
Background. The solubility of desflurane compared with sevoflurane suggests more rapid recovery from desflurane anaesthesia. This could be important after prolonged anaesthesia and fast recovery may be advantageous in the elderly where slow recovery of mental function is a concern. We compared emergence from desflurane vs sevoflurane in elderly patients undergoing two or more hours of anaesthesia.
Methods. Fifty ASA physical status I, II, or III patients, 65 yr of age or older, undergoing anaesthesia expected to last two or more hours were randomly assigned to receive desflurane/nitrous oxide or sevoflurane/nitrous oxide anaesthesia. Patients were given 1–2 µg kg–1 fentanyl i.v. and anaesthesia was induced with propofol 1.5–2.5 mg kg–1 i.v. and maintained with either desflurane 2–6% or sevoflurane 0.6–1.75% with nitrous oxide 65% in oxygen. Inspired anaesthetic concentrations were adjusted to obtain adequate surgical anaesthesia and to maintain mean arterial pressure within 20% of baseline values. Early and intermediate recovery times were recorded. Digit-Symbol Substitution Test (DSST) scores and Visual Analog Scale (VAS) scores for pain and nausea were recorded before pre-medication and every 15 min in the Post Anaesthesia Care Unit (PACU) until patients were discharged.
Results. Early recovery times are given as median, quartiles. The times to extubation (5 (4–9); 9 (5–13) min), eye opening (5 (3–5); 11 (8–16) min), squeezing fingers on command (7 (4–9); 12 (8–17) min); and orientation (7 (5–9); 16 (10–21) min) were significantly less (P<0.05) for desflurane than for sevoflurane. Intermediate recovery, as measured by the DSST and time to ready for discharge from the PACU (56 (35–81); 71 (61–81) min) was similar in the two groups.
Conclusions. Early but not intermediate recovery times of elderly patients undergoing a wide range of surgical procedures requiring two or more hours of anaesthesia is significantly (P
0.05) faster after desflurane.
Br J Anaesth 2003; 91: 502–6
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