Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long-term surgery.
BACKGROUND
The purpose of the study was to compare time of recovery, return of cognitive function, post-anaesthetic care unit (PACU) stay and costs of a propofol/remifentanil (TIVA) with a desflurane/fentanyl-based anaesthesia (desflurane group) in surgical procedures lasting more than 150 min.


METHODS
Forty-nine patients undergoing elective abdominal prostatectomy were allocated randomly to receive bispectal index (BIS)-controlled desflurane/fentanyl (n=24) or propofol/remifentanil (n=25). Awakening, clinical recovery, direct drug acquisition and post-operative pain treatment were documented. Cognitive skills were tested using the Mini-Mental Status (MMST) test.


RESULTS
Extubation was significantly faster with desflurane (6.9+/-3.5 min) than with TIVA (11.2+/-4.0 min) as well as times for stating name and date of birth (desflurane: 6.1+/-3.9 and 6.6+/-4.0 min; TIVA: 12.4+/-11.5 min and 13.4+/-11.3 min). There were no significant differences in PACU discharge times or MMS scores between the groups. Significantly more patients suffered post-operative nausea and vomiting (PONV) in the desflurane (33% vs. 0%) than the TIVA group. Overall costs were significantly higher in the TIVA (58.8+/-11.6 euro) than in the desflurane group (35.0+/-5.7 euro).


CONCLUSIONS
Patients undergoing prolonged surgical procedures showed a faster early recovery after desflurane/fentanyl than using TIVA, whereas stay in the PACU and recovery of cognitive function were similar in both groups. Costs of a TIVA regimen were significantly higher than using a desflurane-based anaesthesia technique.
Röhm
K D
KD
Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Ludwigshafen, Germany.
Piper
S N
SN
Suttner
S
S
Schuler
S
S
Boldt
J
J
D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000191:economics; D018686:Anesthetics, Intravenous / Q000191:economics; D003071:Cognition; D000077335:Desflurane; D016527:Drug Costs; D005283:Fentanyl; D006757:Hospital Units; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives* / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D010880:Piperidines; D020250:Postoperative Nausea and Vomiting; D015742:Propofol; D011468:Prostatectomy; D000077208:Remifentanil
D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077335:Desflurane; D007530:Isoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol