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BJA Advance Access published online on April 13, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael092
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org
Accepted March 14, 2006

Clinical Investigation

Emergence and recovery in children after desflurane and isoflurane anaesthesia: effect of anaesthetic duration

G. R. Nordmann 1 *, J. A. Read 1, S. M. Sale 1, P. A. Stoddart 1, and A. R. Wolf 1

1 Department of Anaesthesia, Bristol Royal Hospital for Children, Bristol, UK

* To whom correspondence should be addressed.
G. R. Nordmann, E-mail: gilesnordmann{at}blueyonder.co.uk


  Abstract

Background. We hypothesized that increasing duration of inhalation anaesthesia is associated with slower emergence and recovery in children, and that this effect would be less marked with desflurane in comparison with isoflurane.

Methods. Fifty-four infants and children assigned in groups according to age and expected length of operation were prospectively randomized to receive either isoflurane (I) or desflurane (D) for anaesthesia. After standard induction, the anaesthesia was maintained using an age-related 1.0 minimum alveolar concentration (MAC) equivalent for either agent in air and oxygen. Local analgesia was used as appropriate. End-tidal volatile agent concentration was recorded until extubation. Clinical evaluation of recovery was made by observers, blinded to group allocation.

Results. For patients <4 yr of age, the median (95% CI) times in minutes to first movement [5.27 (D), 9.22 (I)], eye opening [9.42(D), 13.3(I)] and extubation [7.18 (D), 12.5 (I)] were significantly shorter (P<0.05) for desflurane. In the group >4 yr of age, the median (95% CI) times in minutes to first movement [4.42 (D), 11.6 (I)], eye opening [8.55(D), 18.0(I)] and extubation [7.08 (D), 16.7 (I)] were significantly shorter (P<0.001) for desflurane. Times to leave recovery were not significantly different for the group <4 yr of age, but were significantly shorter for desflurane in the group >4 yr of age (P<0.01). The isoflurane, but not desflurane, had a time-dependent effect on arousal. There were no significant differences in incidence of airway irritation or emergence delirium between the two agents.

Conclusions. The rate of recovery in children after exposure to desflurane was faster than those patients receiving isoflurane; recovery from desflurane, but not isoflurane, was relatively unaffected by the duration of anaesthesia.

Keywords: anaesthesia, paediatric; anaesthetics volatile, desflurane; anaesthetics volatile, isoflurane; recovery, postoperative.
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This article has been cited by other articles:


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 Br J AnaesthHome page
A. D. Farmery, G. R. Nordmann, P. Stoddart, and A. Wolf
Emergence and recovery in children after desflurane and isoflurane anaesthesia.
Br. J. Anaesth., December 1, 2006; 97(6): 899 - 900.
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Exposure-time sensitivity of emergence following volatile anaesthesia
Andrew D Farmery
British Journal of Anaesthesia, 9 Jun 2006 [Full text]
Response to A Farmery's e-letter
Giles R Nordmann, et al.
British Journal of Anaesthesia, 15 Sep 2006 [Full text]

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