Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery

Context:

Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications.

Aim:

Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery.

Settings and Design:

Randomized controlled trial

Materials and Methods:

After institutional ethics committee approval and written informed consent, 40 morbidly obese patients (BMI > 35 kg/m²) were randomized to receive desflurane or sevoflurane as part of a standardized general anesthesia technique. Volatile anesthetic concentration was titrated to maintain electroencephalographic bispectral index score (BIS) in the range of 40-60. Mean arterial pressure (MAP) and heart rate (HR) were recorded preoperatively, at induction and intubation, then at regular intervals. After extubation, early recovery was recorded by time to emergence and orientation to time and place. In post anesthesia care unit, intermediate recovery was assessed by modified Aldrete Score and Digit Symbol Substitution Test (DSST).

Results:

Intraoperative MAP and HR did not differ between the two groups (P > 0.05). The time to response to painful stimuli, obeying verbal commands and spontaneous eye opening was shorter (P = 0.001) and modified Aldrete Score was higher after desflurane anesthesia than after sevoflurane anesthesia (P = 0.049). DSST also returned towards normal faster after desflurane (28.50 ± 6.30 min vs. 35.0 ± 5.62 min, P = 0.03).

Conclusions:

Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients.

Quality of recovery in patients undergoing endoscopic sinus surgery after general anesthesia: total intravenous anesthesia vs desflurane anesthesia

BACKGROUND

For sinus surgery, some centers favor total intravenous anesthesia (TIVA) over inhalation anesthesia. However, whether TIVA affects the patient's perceived quality of recovery remains unclear. This study used the Quality of Recovery-40 questionnaire (QoR-40) to compare patient recovery between surgical patients who received TIVA and those who received desflurane (DES) anesthesia.

METHODS

Eighty patients (20 to 65 years old) undergoing endoscopic sinus surgery were prospectively enrolled and randomized to either the TIVA (propofol and remifentanil infusion) or DES (desflurane inhalation and remifentanil infusion) group. The QoR-40 was administered before surgery, at 6 hours after surgery, and on postoperative day 1 (POD1). Incidence of nausea and vomiting, remifentanil consumption, blood loss, and pain treatment were recorded. The influence of lesion extent (indexed as Lund-Mackay [LM] score) on recovery quality was also assessed.

RESULTS

Forty patients were randomized into the TIVA group, and 40 patients were randomized into the DES group. The QoR-40 score at 6 hours after surgery was significantly higher in the TIVA group compared with the DES group (188.2 vs 182.6, respectively; p = 0.049), indicating a better quality of recovery in the TIVA group. TIVA resulted in less blood loss (p < 0.0001). A high LM score (≥12) was associated with lower QoR-40 scores at 6 hours after surgery (180.2 vs 187.2, p = 0.028) and on POD1 (181.5 vs 190.3, p = 0.003).

CONCLUSION

This study shows that the quality of recovery for endoscopic sinus surgery patients was better with TIVA than with desflurane anesthesia. A high LM score was related to poorer recovery quality.

Effects of dexmedetomidine on sevoflurane requirement for 50% excellent tracheal intubation in children: a randomized, double-blind comparison

OBJECTIVE

We investigated the effects of two dexmedetomidine bolus and infusion combinations on the amount of sevoflurane required to produce 50% excellent tracheal intubation conditions (ED50 TI).

METHODS

In a prospective, double-blinded parallel, randomized manner, 60 children (ASA I or II, age 3-8 years) undergoing elective surgery were allocated to one of three groups: saline only (group D0 ), a bolus dose of 1.0 μg·kg(-1) dexmedetomidine followed by a continuous infusion of 0.5 μg·kg(-1) ·h(-1) (group D1 ), or a bolus dose of 2.0 μg·kg(-1) dexmedetomidine followed by a continuous infusion of 1.0 μg·kg(-1) ·h(-1) (group D2 ). Each bolus dose of dexmedetomidine was infused over 10 min, after which a dexmedetomidine infusion and 5% sevoflurane were immediately begun, with sevoflurane subsequently adjusted to target specific values determined according to Dixon's up-and-down method. After the target concentration of sevoflurane was maintained stable for 15 min, laryngoscopy and tracheal intubation were performed. Intubation was considered excellent only if all subcomponents of the intubation score were rated excellent. Patient enrollment continued until there were six pairs of consecutive patients in which not excellent tracheal intubation conditions were followed by excellent conditions.

RESULTS

The ED50 TI of sevoflurane in group D2 (1.41 ± 0.07%) was significantly lower than in group D1 (2.36 ± 0.16%; P < 0.001), the latter being significantly lower than in group D0 (3.52 ± 0.21%; P < 0.001).

CONCLUSION

Dexmedetomidine infusion produced a dose-dependent decrease in the ED50 TI of sevoflurane in children.