Comparison of the Analgesic Properties of Sevoflurane and Desflurane Using Surgical Pleth Index at Equi-Minimum Alveolar Concentration

Abstract

Background: Traditionally, minimum alveolar concentration (MAC) has been used as the standard measure to compare the potencies of volatile anesthetics. However, it reflects the spinal mechanism of immobility rather than the subcortical mechanism of analgesia. Recently, the surgical pleth index (SPI) derived from photoplethysmographic waveform was shown to reflect the intraoperative analgesic component. This study was designed to compare the SPI values produced by equi-MAC of two commonly used volatile anesthetics, sevoflurane and desflurane.Methods: Seventy-two patients undergoing arthroscopic shoulder surgery were randomly assigned to two groups receiving either sevoflurane (n = 36) or desflurane (n = 36). General anesthesia was maintained with the respective volatile anesthetic only. A vaporizer was adjusted to maintain end-tidal anesthetic concentration at age-corrected 1.0 MAC throughout the study period. The SPI value as an analgesic estimate and the bispectral index (BIS) value as a hypnotic estimate were recorded at predefined time points during the standardized surgical procedure.Results: During the steady state of age-corrected 1.0 MAC, mean SPI values throughout the entire study period were significantly higher in the sevoflurane group than in the desflurane group (38.1 ± 12.8 vs. 30.7 ± 8.8, respectively, P = 0.005), and mean BIS values were significantly higher in the sevoflurane group than in the desflurane group (40.7 ± 5.8 vs. 36.8 ± 6.2, respectively, P = 0.008).Conclusions: Equi-MAC of sevoflurane and desflurane did not produce similar surgical pleth index values. Therefore, sevoflurane and desflurane may have different analgesic properties at equipotent concentrations.

Comparison of Antinociceptive Properties Between Sevoflurane and Desflurane Using Pupillary Dilation Reflex Under Equivalent Minimum Alveolar Concentration: A Randomized Controlled Trial

“…7,12,21,25,26 Among them, only 1 study compared the antinociceptive properties of sevoflurane and desflurane using the SPI and found a difference in the SPI between them. 5,6 In contrast, our study showed that the PDR amplitude after SNT did not differ under sevoflurane and desflurane anesthesia. The main reason for this discrepancy may be the different contributions of sevoflurane and desflurane to vascular tone, and the SPI is a parameter based on HR and pulse plethysmographic waveforms, 27 which can be affected by change in vascular tone.…”

“…In a recent study, 5,6 the possibility of sevoflurane and desflurane possessing different antinociceptive potencies was suggested by comparing the surgical pleth index (SPI) under equivalent minimal alveolar concentration (equi-MAC) of sevoflurane and desflurane anesthesia. The SPI is derived from the normalized plethysmographic pulse-wave amplitude and heartbeat interval, thereby involving a combined assessment of symphatetically mediated peripheral vasoconstriction and cardiac autonomic tone.…”

“…The SPI is derived from the normalized plethysmographic pulse-wave amplitude and heartbeat interval, thereby involving a combined assessment of symphatetically mediated peripheral vasoconstriction and cardiac autonomic tone. 7 Ryu et al 5,6 mentioned that SPI might have reflected the different effects on vascular tone of each volatile anesthetic. In their follow-up study, a higher perfusion index was shown in desflurane anesthesia than in sevoflurane anesthesia, which suggests that desflurane has greater vasodilation properties than sevoflurane at equi-MAC.…”

Comparison of the Level of Free Hexafluoro-isopropanol in Adults’ Blood and the Incidence of Emergence Agitation After Anesthesia With Different Concentrations of Sevoflurane in Laparoscopic Gastrointestinal Surgery: A Randomized Controlled Clinical Trial

“…The study found that the incidence of EA was not affected by free HFIP after anesthesia with different concentrations of sevoflurane in adults. A delayed recovery in the highest inhaled sevoflurane concentration group (Table I) may mainly relate to the effect of more accumulation of sevoflurane in the body 18 ( Figure 2) and relate less to the residual anesthetic efficacy of free HFIP. In other words, the clinical indexes of recovery will not be influenced by a small rate or extend of sevoflurane metabolism.…”

So Sánh Hiệu Quả Duy Trì Mê Của Desflurane Và Sevoflurane Trong Gây Mê Điều Trị Viêm Tủy Răng Ở Trẻ Em

“…Theo Isik và cs (2006) khi so sánh gây mê desflurane với lưu lượng thấp và sevoflurane ở trẻ em cho thấy gây mê desflurane lưu lượng thấp không gây ảnh hưởng xấu đến huyết động, chức năng gan thận và cho thời gian hồi phục ngắn hơn so với sevoflurane [1].…”