Clinical Observation Of Desflurane Anesthesia Applied In Elderly Patients

Objective Desflurane is one of the third-generation inhaled anaesthetics,which is not used extensively in clinical practice in contrast to propofol currently.In this study,we compared hemodynamic changes and postoperative recovery quality of desflurane and propofol during the maintenance of anesthesia.It aims to seek a better maintenance methods for anesthesia in the aged,and provide references for clinical anesthesia.Methods Sixty elderly patients with American Society of Anesthesiologists physical status(ASA)II or III undergoing open reduction and internal fixation of humeral fractures surgery are randomly devided into 2 groups(30 patients),which are desflurane group(group D)and propofol group(group P),and the ages of both groups was between 65 to 79 years old.Two groups of patients were both used etomidate(0.2mg/kg),propofol(0.6mg/kg),sufentanil(0.4ug/kg)and cisatracurium(0.2mg/kg)for anesthesia induction.The anesthesia was maintained by desflurane inhalation in D group and intravenous infusion of propofol in P group,and the two groups were target-controlled infusion of remifentanil(3.5ng·ml-1)in surgery.Muscle relaxants was used intermittently during operation and stoped using after half an hour before surgery ends.The both groups all made the narcotrend index to maintain 45 to 55 by adjust the propofol dosage and concentration of desflurane inhalation respectively.We record the value of heart rate(HR),systolic blood pressure(SBP),diastolic blood pressure(DBP),Mean arterial pressure(MAP)and Narcotrend during operation,record the time to eye opening,the time to extubation,the recovery time to directional force,the time to leave the operating room and emergence agitation after surgery ends,and also record the incidence of adverse events such as nausea and vomiting.Then the differences of MAP,HR changes and postoperative recovery quality were compared between the two groups.Results Seven patients in this study were withdrawn from the trial for using vasoactive drugs,so 53 cases were statistically analyzed(28 in group D and 25 ingroup P)actually.There were no significant differences in age,sex,body weight,ASA grade,operation time,intraoperative infusion volume and blood loss between the two groups(P>0.05),and both of the two groups did not occur intraoperative awareness.The MAP and HR changes of desflurane group was more stable than propofol group,there was a statistically significant difference between them.The time to eye opening,the time to extubation,the recovery time to directional force and the time to leave the operating room of desflurane group was shorter than propofol group,which was significant statistical significance in both groups(P <0.01).While the emergence agitation rate of desflurane group was higher than propofol group in spite of no statistically difference between the two groups(P>0.05).Also,there was no significant difference in the incidence of nausea and vomiting between the two groups(P> 0.05).Conclusion Desflurane can maintain more stable haemodynamics than propofol during the maintenance of anesthesia in the open reduction and internal fixation of humeral fractures surgery.And the awakening time,the time to extubation,the recovery time to directional force and the time to leave the operating room of desflurane group was shorter than propofol group,meanwhile it did not increase the incidence of postoperative nausea and vomiting.Our study shows that desflurane is an ideal choice for general anesthesia maintenance phase in elderly patients undergoing surgery.