BACKGROUND:Desflurane in neurosurgery may be beneficial because it facilitates postoperative early neurologic evaluation. However, its use has been debated because of its capacity to promote cerebral vasodilatation. Sevoflurane has been extensively used in neurosurgical patients. In this prospective clinical trial, we compared early postoperative recovery and cognitive function in patients undergoing craniotomy for supratentorial expanding lesions and receivingsevoflurane or desflurane anesthesia. METHODS:One hundred twenty patients, ASA physical statusI-III (66 men), Glascow Coma Scale 15, undergoing craniotomy for supratentorial expanding lesions were enrolled in the study. Patients were randomly allocated to two anesthetic regimens. In Group S (60 patients, 52 +/- 16 yr), anesthesia was maintained using sevoflurane with end-tidal of 1.5%-2% and was age adjusted to obtain approximately 1.2 minimum alveolar anesthetic concentration. In Group D (60 patients, 60 +/- 14 yr), anesthesia was maintained using desflurane with end-tidal of 6%-7% and was age adjusted to obtain approximately 1.2 minimum alveolar concentration. Emergence time was measured as the time from drug discontinuation to the time at which patients opened their eyes; tracheal extubation time was measured as the time from anesthetic discontinuation and tracheal extubation. Recovery time was measured as the time elapsing from discontinuation of anesthetic and the time when patients were able to recall their name and date of birth. Cognitive behavior was evaluated with the Short Orientation Memory Concentration Test. In the postanesthesia care unit, a blinded observer monitored the patients for 3 h; the incidence of hemodynamic events, pain, nausea, and shivering requiring rescue medication was recorded. RESULTS: The mean emergence time (12.2 +/- 4.9 min in Group S vs 10.8 +/- 7.2 min in Group D; P = ns) was similar in the two groups, whereas the mean extubation time and recovery time were longer in Group S (15.2 +/- 3.0 min in Group S vs 11.3 +/- 3.9 min in Group D and 18.2 +/- 2.3 min in Group S vs 12.4 +/- 7.7 min in Group D, respectively; P < 0.001). The Short Orientation Memory Concentration Test score differed between the two groups only at the earliest assessment (15 min after extubation). No difference between the two groups was found in pain, shivering, nausea, vomiting, and incidence of postoperative hemodynamic events. CONCLUSION: Patients who received desflurane had a shorter extubation and recovery time but similar intraoperative and postoperative incidence of complications compared with those who received sevoflurane.
RCT Entities:
BACKGROUND:Desflurane in neurosurgery may be beneficial because it facilitates postoperative early neurologic evaluation. However, its use has been debated because of its capacity to promote cerebral vasodilatation. Sevoflurane has been extensively used in neurosurgical patients. In this prospective clinical trial, we compared early postoperative recovery and cognitive function in patients undergoing craniotomy for supratentorial expanding lesions and receiving sevoflurane or desflurane anesthesia. METHODS: One hundred twenty patients, ASA physical status I-III (66 men), Glascow Coma Scale 15, undergoing craniotomy for supratentorial expanding lesions were enrolled in the study. Patients were randomly allocated to two anesthetic regimens. In Group S (60 patients, 52 +/- 16 yr), anesthesia was maintained using sevoflurane with end-tidal of 1.5%-2% and was age adjusted to obtain approximately 1.2 minimum alveolar anesthetic concentration. In Group D (60 patients, 60 +/- 14 yr), anesthesia was maintained using desflurane with end-tidal of 6%-7% and was age adjusted to obtain approximately 1.2 minimum alveolar concentration. Emergence time was measured as the time from drug discontinuation to the time at which patients opened their eyes; tracheal extubation time was measured as the time from anesthetic discontinuation and tracheal extubation. Recovery time was measured as the time elapsing from discontinuation of anesthetic and the time when patients were able to recall their name and date of birth. Cognitive behavior was evaluated with the Short Orientation Memory Concentration Test. In the postanesthesia care unit, a blinded observer monitored the patients for 3 h; the incidence of hemodynamic events, pain, nausea, and shivering requiring rescue medication was recorded. RESULTS: The mean emergence time (12.2 +/- 4.9 min in Group S vs 10.8 +/- 7.2 min in Group D; P = ns) was similar in the two groups, whereas the mean extubation time and recovery time were longer in Group S (15.2 +/- 3.0 min in Group S vs 11.3 +/- 3.9 min in Group D and 18.2 +/- 2.3 min in Group S vs 12.4 +/- 7.7 min in Group D, respectively; P < 0.001). The Short Orientation Memory Concentration Test score differed between the two groups only at the earliest assessment (15 min after extubation). No difference between the two groups was found in pain, shivering, nausea, vomiting, and incidence of postoperative hemodynamic events. CONCLUSION:Patients who received desflurane had a shorter extubation and recovery time but similar intraoperative and postoperative incidence of complications compared with those who received sevoflurane.
Authors: Christopher G Hughes; Christina S Boncyk; Deborah J Culley; Lee A Fleisher; Jacqueline M Leung; David L McDonagh; Tong J Gan; Matthew D McEvoy; Timothy E Miller Journal: Anesth Analg Date: 2020-06 Impact factor: 5.108
Authors: Anthony G Messina; Michael Wang; Marshall J Ward; Chase C Wilker; Brett B Smith; Daniel P Vezina; Nathan Leon Pace Journal: Cochrane Database Syst Rev Date: 2016-10-18