A comparison between sevoflurane and desflurane anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery.
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.


CONCLUSIONS
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.
Magni
Giuseppina
G
Department of Anesthesia and Intensive Care, La Sapienza University, Policlinico Umberto I Roma, Rome, Italy. gmagni@yahoo.co
Rosa
Italia La
IL
Melillo
Guido
G
Savio
Angela
A
Rosa
Giovanni
G
D000328:Adult; D000368:Aged; D000762:Anesthesia Recovery Period; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D001784:Blood Gas Analysis; D001921:Brain / Q000502:physiology; D003071:Cognition / Q000187:drug effects / Q000502:physiology; D003399:Craniotomy; D000077335:Desflurane; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011184:Postoperative Period; D012140:Respiratory Tract Diseases / Q000453:epidemiology; D000077149:Sevoflurane; D012768:Shivering / Q000187:drug effects; D015173:Supratentorial Neoplasms / Q000601:surgery*; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane