Anaesthetic agents in adult day case surgery

Early recovery properties of sevoflurane and desflurane in patients undergoing total hip replacement surgery

BACKGROUND

The pharmacokinetic properties of sevoflurane and desflurane differ from those of other volatile anesthetics. For example, both agents allow more rapid emergence than traditional volatile anesthetics. However, few direct comparisons of the 2 agents have been made.

OBJECTIVE

The aim of this study was to compare the early recovery properties of desflurane and sevoflurane in patients with American Society of Anesthesiologists physical status I or II undergoing total hip replacement (THR) surgery.

METHODS

This open-label study was performed at the Department of Anesthesiology, Erciyes University School of Medicine, Kayseri, Turkey. Early recovery was assessed in the surgical suite by measuring the time to 50% decline of end-tidal volatile concentration of desflurane or sevoflurane; time to extubation, eye opening, orientation, and a modified Aldrete Scale (MAS) score >8 (ie, safe to discharge from the surgical suite); and time to discharge from the postanesthesia recovery room.

RESULTS

Time to 50% decline of end-tidal volatile concentration of desflurane or sevoflurane, tracheal extubation, eye opening, orientation, and an MAS score >8 occurred significantly more rapidly in the desflurane group than in the sevoflurane group (P<0.001). However, the groups did not differ significantly in duration of anesthesia; time to discharge from the postanesthesia recovery room; or incidences of nausea, vomiting, dizziness, and drowsiness in the first 24 hours after anesthesia.

CONCLUSIONS

In this study population, desflurane provided significantly more rapid early recovery than sevoflurane, but we did not find any beneficial effects of desflurane on intermediate recovery. The rapid emergence from anesthesia may facilitate more efficient surgical suite use and may be associated with more benefits after prolonged anesthesia. We suggest that both volatile agents may be acceptable anesthetics for use during THR surgery.

Comparison of recovery profile for propofol and sevoflurane anesthesia in cases of open cholecystectomy

Objective:

Sevoflurane and propofol are considered to be the agents of choice in surgeries of short duration due to their better recovery profile and few post-operative complications. This study was designed to compare the early recovery profile of sevoflurane and propofol anesthesia in patients undergoing open cholecystectomy.

Materials and Methods:

A total of 60 patients of either sex with American Society of Anesthesiologists grade 1 and 2 scheduled for elective cholecystectomy were prospectively randomized into two groups. Group S (30 patients) were maintained with sevoflurane anesthesia (1-2%), while in Group P (30 patients) were maintained with propofol infusion (75-125 μg/kg/min) in both the groups the anesthetic concentration/dose was so adjusted to keep hemodynamic parameter (mean arterial pressure and heart rate) within 15% of their respective baselines values.

Results:

It was observed that there was no significant difference (P > 0.05) between there early recovery profile that includes spontaneous eye opening (7.5 ± 1.6 min for sevoflurane group and 6.9 ± 1.7 min for propofol group), following simple verbal command (9.2 ± 2.2 min for sevoflurane group and 8.9 ± 1.9 min for propofol group) and extubation time (10.7 ± 2.3 min for sevoflurane group and 10.3 ± 2.0 min for propofol group) but there was a significant difference (P < 0.05) in incidence of post-operative nausea and vomiting (PONV) in both groups.

Conclusion:

Propofol is as good as sevoflurane for maintenance of anesthesia in surgeries like open cholecystectomy with an added advantage of lower incidence of PONV owing to its intrinsic antiemetic properties.