title: Comparison of desflurane and sevoflurane anaesthesia in relation to the risk of vagally mediated reflex bradycardia during gastrectomy.
abstract: OBJECTIVE
  This study compared the risk of clinically significant reflex bradycardia during anaesthesia with sevoflurane or desflurane in patients undergoing gastrectomy.
  
  
  METHODS
  In this randomized prospective study, 100 patients undergoing gastrectomy were assigned to receive sevoflurane (n=50) or desflurane (n=50) anaesthesia. No anticholinergic prophylaxis was administered. Symptomatic reflex bradycardia was defined as a sudden decrease in heart rate to <50 beats/min, or a decrease to 50-59 beats/min if associated with a systolic arterial pressure of 70 mmHg in response to surgical manoeuvres. If reflex bradycardia developed, atropine or ephedrine were administered according to a predefined treatment protocol.
  
  
  RESULTS
  Data from 85 patients were available for analysis. The proportion of patients with symptomatic reflex bradycardia in the sevoflurane and desflurane groups was similar (69.0% versus 55.8%, respectively) and both groups required a similar amount of atropine and/or ephedrine.
  
  
  CONCLUSIONS
  Clinically significant reflex bradycardia occurred with a relatively high frequency during gastrectomy. Although desflurane is associated with sympathetic activation, it did not provide a protective effect against vagally mediated reflex bradycardia during gastrectomy compared with sevoflurane.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Republic of Korea.
authors.forename: Y
authors.initials: Y
authors.lastname: Joo
authors.forename: B-S
authors.initials: BS
authors.lastname: Shin
authors.forename: E-A
authors.initials: EA
authors.lastname: Cho
authors.forename: D-K
authors.initials: DK
authors.lastname: Kim
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D001919:Bradycardia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D000077335:Desflurane; D004809:Ephedrine / Q000008:administration & dosage; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007530:Isoflurane / Q000031:analogs & derivatives*; D008297:Male; D008738:Methyl Ethers; D008875:Middle Aged; D011446:Prospective Studies; D000077149:Sevoflurane; D014630:Vagus Nerve / Q000502:physiology
chemical_list: D018685:Anesthetics, Inhalation; D000889:Anti-Arrhythmia Agents; D008738:Methyl Ethers; D000077149:Sevoflurane; D001285:Atropine; D000077335:Desflurane; D007530:Isoflurane; D004809:Ephedrine