Elderly patients recover more rapidly from desflurane than from isoflurane anesthesia.
OBJECTIVE
To compare the hemodynamic, emergence, and recovery characteristics of desflurane-nitrous oxide (N2O) anesthesia with those of isoflurane-N2O anesthesia in elderly patients.


METHODS
Randomized study.


METHODS
Main operating room of a major U.S. teaching hospital.


METHODS
Thirty-four ASA physical status II and III patients aged 65 or older undergoing surgical procedures of greater than 1 hour duration.


METHODS
Group 1 (17 patients) received desflurane in 60% N2O for their surgical procedure. Group 2 (17 patients) received isoflurane in 60% N2O. Thiamylal 2 mg/kg administered intravenously (IV) induced anesthesia, and succinylcholine 1.5 mg/kg i.v. facilitated intubation. Muscle relaxation was maintained with vecuronium. Titration of the anesthetics maintained hemodynamics to within 20% of the patients' preinduction values.


RESULTS
Measurement of hemodynamics occurred every 2 minutes prior to skin incision and every 5 minutes thereafter. The times for discontinuation of inhaled anesthetics to eye opening, hand grip on command, and recall of name and date of birth were measured in a standardized fashion for both groups. The time to discharge from the postanesthesia care unit (PACU) was determined by a blinded PACU nurse using standard published criteria. The two groups did not differ with respect to demographics, hemodynamic stability, and times to eye opening (5 +/- 3 minutes for desflurane vs. 8 +/- 4 minutes for isoflurane), hand grip on command (9 +/- 4 minutes vs. 12 +/- 1 minutes), and recall of name and date of birth (13 +/- 8 minutes vs. 12 +/- 7 minutes). The median duration of PACU stay was significantly shorter (p < 0.03) in the desflurane group (80 minutes) compared to the isoflurane group (128 minutes).


CONCLUSIONS
Desflurane may benefit elderly patients by providing a more rapid recovery from anesthesia, leading to a shorter PACU stay.
Bennett
J A
JA
Department of Anesthesiology, Hahnemann University, Philadelphia, PA 19102.
Lingaraju
N
N
Horrow
J C
JC
McElrath
T
T
Keykhah
M M
MM
D000368:Aged; D000375:Aging / Q000502:physiology*; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D000777:Anesthetics / Q000008:administration & dosage / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D003243:Consciousness / Q000187:drug effects; D000077335:Desflurane; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology; D007902:Length of Stay; D008297:Male; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000627:therapeutic use
D000777:Anesthetics; D009020:Morphine; D000077335:Desflurane; D007530:Isoflurane; D005283:Fentanyl