Recovery Properties Of Sevoflurane And Desflurane In Elderly Patients Undergoing Total Hip Replacement Surgery

Objective: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. The aim of this study was to compare the early recovery properties of desflurane and sevoflurane and find a better one in elderly patients with American Society of Anesthesiologists physical status II or III undergoing total hip replacement(THR) surgery.Methods:This open-label study was performed at the Department of Anesthesiology,China-Japan United Hospital. Elderly patients with American Society of Anesthesiologists physical status II or III undergoing total hip replacement(THR)surgery randomly devided into 2 groups, which are desflurane group(group D, 25patients) and sevoflurane group(group S, 25 patients).After the patients enter the operating room, regular monitor their ECG, and SpO2%. Open the vein channel in upper extremity, measure the invasive radial artery blood pressure under local anesthesia. Oxygen inhalation 3min before induction, intravenous midazolam(0.03mg/kg), cisatracurium(0.2 mg/kg), fentanyl(4 μg/kg) and propofol(1.2 mg/kg)for anesthesia induction. After loss of consciousness and the muscle relaxant worked,the trachea was intubated. Connect the breathing machine after successful endotracheal intubation, controlled by volume controlled ventilation, tidal volume is 8~10 ml/kg. Anesthesia was maintained with either sevoflurane 1.5% to 3%or desflurane 4% to 8%. The inspired concentration of the volatile anesthetic was adjusted to maintain mean arterial pressure within 20% of baseline values. Gradually increase the suction volume fraction, every time increased by 1%, until anesthesia depth reached around 1.3 MAC. At the end of surgery, patients were given neostigmine 1mg and atropine 0.5 mg, and the inhaled anesthetics were discontinued.The lungs were ventilated with 100% oxygen at a fresh gas flow rate of 3L/min. Thetrachea was extubated when a regular spontaneous breathing pattern had been reestablished and the patient was able to open his or her eyes on command. Early recovery was assessed in the surgical suite by measuring the 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 tracheal extubation, eye opening, orientation, an MAS score>8 and time to discharge to the postanesthesia recovery room occurred significantly more rapidly in the desflurane group than in the sevoflurane group(P<0.05). However, the groups did not differ significantly in duration of anesthesia; 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.