Desflurane Allows for a Faster Emergence When Compared to Sevoflurane without Affecting the Baseline Cognitive Recovery Time

Abstract

AimsWe compared the effect of desflurane and sevoflurane on anesthesia recovery time in patients undergoing urological cystoscopic surgery. The Short Orientation-Memory-Concentration Test (SOMCT) measured and compared cognitive impairment between groups and coughing was assessed throughout the anesthetic.Methods and materialsThis investigation included 75 ambulatory patients. Patients were randomized to receive either desflurane or sevoflurane. Inhalational anesthetics were discontinued after removal of the cystoscope and once repositioning of the patient was final. Coughing assessment and awakening time from anesthesia were assessed by a blinded observer.Statistical analysis usedStatistical analysis was performed by using t-test for parametric variables and Mann–Whitney U test for non-parametric variables.ResultsThe primary endpoint, mean time to eye-opening, was 5.0 ± 2.5 min for desflurane and 7.9 ± 4.1 min for sevoflurane (p < 0.001). There were no significant differences in time to SOMCT recovery (p = 0.109), overall time spent in the post-anesthesia care unit (PACU) (p = 0.924) or time to discharge (p = 0.363). Median time until readiness for discharge was 9 min in the desflurane group, while the sevoflurane group had a median time of 20 min (p = 0.020). The overall incidence of coughing during the perioperative period was significantly higher in the desflurane (p = 0.030).ConclusionWe re-confirmed that patients receiving desflurane had a faster emergence and met the criteria to be discharged from the PACU earlier. No difference was found in time to return to baseline cognition between desflurane and sevoflurane.

Early postoperative recovery after intracranial surgical procedures. Comparison of the effects of sevoflurane and desflurane

“…Desflurane has a lower solubility coefficient than sevoflurane (blood/gas: 0.42/0.69, fat/ blood: 27.2/47.5, brain/blood: 1.29/1.70). Despite many studies in which desflurane has been associated with a shorter emergence, early recovery time and early return of consciousness, particularly after long-duration surgeries because of low fat/blood and brain/ blood solubility coefficients 5,6 , a few reports from randomised clinical trials suggest that desflurane allows an earlier extubation time and shorter recovery time when compared with sevoflurane in patients undergoing intracranial surgery 7,8 . The different types of intravenous opioids affect postoperative recovery durations.…”

Emergence times and airway reactions during general anaesthesia with remifentanil and a laryngeal mask airway

“…Opioids have an important influence on upper airway events, 25 – 27 the requirements for propofol or volatile anaesthetics, 28 purposeful intra-operative movements 29 and, depending on the administration time point, also on emergence times. 30 In contrast to similar studies, 5 , 13 , 14 , 31 we used remifentanil during maintenance of anaesthesia, based on its predictable pharmacokinetics, excellent controllability, and liver and renal independent elimination. To date, most studies 10 , 32 – 37 have used fentanyl, typically at unstandardised dosages.…”

“…Our emergence results are consistent with our meta-analysis 5 and more recent studies. 14 , 31 In contrast to almost all previously performed studies, we used the primary outcome variable ‘time to state the date of birth’, which demands a higher level of consciousness than ‘time to open the eyes’. Eye opening on command may be a type of unconscious reaction, likely explaining the similar results for this outcome in comparisons of desflurane and propofol and of desflurane and sevoflurane observed in a recent study.…”

“…Five studies revealed a high risk of detection bias. 6 – 10 Furthermore, previous studies were restricted to gynaecological, 11 , 12 urological 13 , 14 or orthopaedic surgery. 7 – 9 Thus, there is a need to address the issue of airway complications in an adequately powered study, ideally with a low risk of bias, and the inclusion of several types of surgery.…”

Environmental safety: Air pollution while using MIRUS™ for short‐term sedation in the ICU

“…AnaConDa™ and MIRUS™ reflect VA and can be used with standard ICU ventilators. Both systems deliver isoflurane (ISO) and sevoflurane (SEVO), but MIRUS™ can also be used with desflurane (DES), which might be useful for short‐term sedation …”