Comparison Of Desflurane And Sevoflurane For Postoperative Recovery Period Of Morbidly Obese Patients

Objective:To observe the comparatively awakening situation of desflurane andsevoflurane applied in morbidly obese patients at the end of the surgery.Record the first spontaneous breathing recovery time, the first abnormalmovement time, time to eye opening following instructions, residence time inPACU, and record the incidence of adverse events such as nausea and vomiting.Methods:Randomly divide47ASA Ⅱ～Ⅲ morbidly obese patients undergoing electiveabdominal surgery (BMI)35kg/m2or47cases into desflurane group (group D,24cases) and sevoflurane group (group S,23cases). After the patients enterthe operating room, regular monitor their ECG, ECG and oxygen saturation SpO2%.Open the vein channel in upper extremity, measure the radial artery bloodpressure after percutaneous tube under local anesthesia. Oxygen inhalation3min before induction, intravenous midazolam (0.1mg/kg), propofol (2mg/kg)and fentanyl (4μg/kg) for anesthesia induction, intravenous muscle relaxantCisatracurium (0.15mg/kg).After the patients fell to sleep and the musclerelaxant worked, then apply endotracheal intubation, connect the breathingmachine after successful endotracheal intubation, controlled by volumecontrolled ventilation, tidal volume is8～10ml/kg. Maintaining anesthesiafor both groups with N2O/O21:1low flow (1～2L/min) inhalation, graduallyincrease the suction volume fraction, every time increased by1%, untilanesthesia depth reached around1.3MAC. Keep hemodynamic indexs within+/-20%of those in induction of anesthesia. the time and dosage of muscle relaxantdrugs and analgesic drugs for the two groups of patients are all the same,stop N2O inhaled15min before the end of surgery, use the diminishing flowreduce desflurane and sevoflurane inhalation, stop the inhalation ofdesflurane and sevoflurane at the end of the surgery. At the same time, inorder to prevent postoperative residual effect of muscle relaxant, the patients were intravenous with1mg neostigmine and0.5mg atropine. At the timeof stopping inhalant anesthetics, record the first spontaneous breathingrecovery time, the first abnormal movement time, the time to eye openingfollowing instructions, the time to extubation, the residence time in PACU,and record the incidence of adverse events such as nausea and vomiting.Results:1. The first spontaneous breathing recovery time, the first abnormal movementtime, time to eye opening following instructions and the time to extubationof desflurane group were all reduced when compared with sevoflurane group,P＜0.05.2. The residence time in PACU of sevoflurane group was extended when comparedwith desflurane group, P＜0.05.3. The intraoperative awareness was not occurred in both groups. The follow-upof postoperative nausea and vomiting in desflurane group were9cases, and2cases in sevoflurane group, the difference is statistically significant,P＜0.05.Conclusion:Compared with sevoflurane, the postoperative awakening time was obviouslyreduced in morbidly obese patients applied desflurane inhalation anesthetics.But the incidence of nausea and vomiting was higher in desflurane group thansevoflurane group. The residence time in PACU of morbidly obese patients wasshorter in desflurane inhalation anesthetics group, accelerated the operationflow.