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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 8  |  Issue : 3  |  Page : 140-144

Comparison of haemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day-care surgical procedure


Department of Anaesthesia, C. U. Shah Medical College, Surendranagar, Gujarat, India

Date of Web Publication24-Sep-2018

Correspondence Address:
Palak A Chudasama
B/304, Enigma Flats, B/S The Grand Cambay Hotel, Thaltej, Ahmedabad - 380 054, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_27_18

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  Abstract 


Background: Smooth and rapid induction, optimal operating conditions and rapid recovery with minimal side effects such as nausea, vomiting, bleeding and post-operative pain are the characteristics of ideal anaesthetic. Objectives: The objective of the study was to compare the haemodynamic parameters and recovery characteristics of desflurane with sevoflurane. Materials and Methods: This was a prospective study conducted from January to December 2016. Using convenient sampling technique, a total of 40 adult patients of American Society of Anesthesiologists (ASA) physical status Grade I or II, aged between 18 and 60 years, of either sex, who were scheduled for elective day-care surgeries of <2 h duration under general anaesthesia were selected for the study after informed consent. All the patients were randomly allocated into one of the two groups using computer-generated random number table. Group I received induction with sevoflurane, while Group II was induced desflurane. Results: The baseline demographic analysis showed that the two groups did not differ significantly in age, weight, sex, ASA grade and operative times. During the course of surgery, heart rate was significantly low in Group II at 25, 30, 40 and 45 min than in Group I. Systolic and diastolic blood pressure was significantly low in group Desflurane as compared to sevoflurane. Group I showed significantly higher time for spontaneous eye opening and recalling names and recognising surroundings and post-operative complications compared to Group II. Conclusion: Desflurane has significantly better haemodynamic stability, post-operative recovery and less post-operative complications compared to sevoflurane.

Keywords: Day-care surgery, desflurane, hemodynamic changes, recovery, sevoflurane


How to cite this article:
Chudasama PA, Mehta MV. Comparison of haemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day-care surgical procedure. Adv Hum Biol 2018;8:140-4

How to cite this URL:
Chudasama PA, Mehta MV. Comparison of haemodynamic parameters and recovery characteristics between sevoflurane and desflurane in patients undergoing day-care surgical procedure. Adv Hum Biol [serial online] 2018 [cited 2020 Oct 22];8:140-4. Available from: https://www.aihbonline.com/text.asp?2018/8/3/140/241928




  Introduction Top


Smooth and rapid induction, optimal operating conditions and rapid recovery with minimal side effects such as nausea, vomiting, bleeding and post-operative pain are the characteristics of ideal anaesthetic.[1] Due to precision in monitoring and advanced surgical techniques, nowadays, major surgical procedures with high-risk patients can now be carried out safely.[2] Choice of anaesthetic technique is the main factor to determine the speed of recovery from anaesthesia. General anaesthesia is the most commonly used technique in day-care setup.[1],[3]

Inhaled volatile has an ease of administration and predictable intraoperative and recovery characteristics and that's why it remains the most widely used drugs for maintenance of general anaesthesia. Standardised balanced technique includes the management of haemodynamic stability and early recovery.[4],[5],[6]

Sevoflurane, a volatile anaesthetic agent, is a halogenated methyl propyl ether. It is non-irritant, non-inflammable and produces bronchodilatation. Due to low blood/gas partition coefficient, it has rapid induction. It can be used for inhalational induction [7],[8] and develop dose-dependent cardiovascular and respiratory depression. Sevoflurane does not activate the sympathetic nervous system.[9] Desflurane is a fluorinated methyl ethyl ether and has a pungent odour, irritable to the respiratory tract and non-inflammable. Low solubility of desflurane in blood and body tissues leads to rapid induction and recovery. It does not predispose to ventricular arrhythmias.[3],[7],[8]

Monitoring of haemodynamic characteristics includes electrocardiogram (ECG), oxygen saturation, non-invasive mean arterial pressure, heart rate (HR) and end-tidal CO2 (EtCO2). Early recovery facilitated by rapid and short-acting drugs for induction and maintenance of anaesthesia and following day-care surgery.[3] Hence, this study was carried out with the objective to compare the haemodynamic parameters and recovery characteristics of desflurane with sevoflurane.


  Materials and Methods Top


Study setting and duration

This study was conducted in the Department of Anesthesiology within the premises of tertiary care hospital of Ahmedabad.

Study design and study population

This was a prospective study designed to compare the haemodynamic and recovery profile of patients administered with desflurane vis-à -vis sevoflurane for general anaesthesia. Using convenient sampling technique, a total of 40 adult patients of the American Society of Anesthesiologists (ASA) physical status Grade I or II, aged between 18 and 60 years, of either sex, who were scheduled for elective day-care surgeries under general anaesthesia were selected for the study after informed consent. Patients who did not provide consent to be included in the study or patients with correlated cardiovascular, pulmonary, renal disease or history of hypersensitivity to halogenated anaesthetic agents were excluded from the study. All the patients were randomly allocated into one of the two groups using computer-generated random number table. Hence, each group contained a total of twenty patients.

Anaesthesia technique: Induction, maintenance and recovery

Pre-anaesthetic check-up was performed the day before and on the day of surgery. Basic routine investigations such as haemoglobin, renal function tests, serum electrolytes, random blood sugar and chest X-ray posteroanterior view were done and recorded. In the operating room, all standard monitors such as non-invasive blood pressure (NIBP), pulse oximetry (SpO2), ECG and capnography (EtCO2) were attached and vital parameters of the patient recorded. All the patients in both groups were pre-medicated with injection glycopyrrolate 4 mcg/kg intravenous (IV), injection fentanyl 1 mcg/kg IV and injection lidocaine 1.5 mg/kg IV. In both groups, after pre-oxygenation with 100% O2 for 3 min, anaesthesia was induced using injection propofol 2 mg/kg IV. This was followed by endotracheal intubation facilitated using injection succinylcholine 2 mg/kg IV. Intubation was confirmed with EtCO2 and injection vecuronium 0.05 mg/kg IV was given after return of respiration.

In Group I, anaesthesia was maintained using sevoflurane (1.5%), nitrous oxide (50%) and oxygen (50%) with intermittent injection of vecuronium. In Group II, anaesthesia was maintained with desflurane (3%), nitrous oxide (50%) and oxygen (50%) with injection of vecuronium intermittently.

Administration of volatile anaesthetic agents and oxygen was discontinued at the end of surgery after the onset of spontaneous respiration. Neuromuscular blockade was reversed with injection neostigmine 50 mcg/kg iv and injection glycopyrrolate 8 mcg/kg IV. Extubating of trachea was done when patients were adequately recovered from the effects of neuromuscular blockade with regular breathing pattern and were able to respond to verbal commands. Time of extubation and the times at which patients were able to state their name were recorded.

Measurement tools

The HR, NIBP, oxygen saturation (SpO2) and EtCO2 were recorded preoperatively, every minute from induction and intubation for 5 min, at 15 min intervals during surgery and after extubation at 5, 10, 15 and 30 min. Emergence was assessed at 15 s intervals after discontinuation of the volatile anaesthetic. Times since discontinuation of anaesthetic agent were recorded. The time at which the patients opened their eyes and responded to verbal command was recorded. Anaesthesia time and operative time were also recorded. Post-operative follow-up for complications such as nausea, vomiting and general discomfort was done for 24 h.

Data analysis

Qualitative data were expressed as percentages and proportions. Quantitative data were expressed as mean and standard deviation. The differences between two groups with respect to continuous variables were analysed using unpaired t-test, while categorical variables were analysed using Chi-square test. All the statistical tests were performed in Epi Info 3.5.1 software by CDC (Atlanta, Georgia, USA).[6] P < 0.05 was considered statistically significant, while P < 0.01 was considered statistically highly significant.

Ethical consent

Before proceeding with the study, appropriate ethical clearance was obtained from the Hospital Ethics Committee. Each patient was included in the study only after informed consent.


  Results Top


A total of 40 patients aged 18–60 years belonging to ASA Grade I–II were included in the study in two equal random groups. [Table 1] of baseline demographic analysis showed that the two groups did not differ significantly in age, weight and sex. Both the groups were comparable with respect to ASA grade and operative time (the difference was non-significant).
Table 1: Baseline characteristics of the patients

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[Table 2] shows that HR was statistically significantly higher in sevoflurane group than desflurane group at 25, 30, 40 and 45 min of post-operative measurement (P < 0.05). There was no significant difference between pre-operative HR of both the groups (>0.05).
Table 2: Mean heart rate (beats per minute) with standard deviation at various intervals

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[Table 3] shows that systolic blood pressure (BP) was statistically significantly higher in sevoflurane group than desflurane group at 10, 15, 20, 25, 30 and 45 min of post-operative measurement (P < 0.05). Diastolic BP was statistically significantly higher in sevoflurane group than desflurane group at 5, 10, 20, 35 and 40 min of post-operative measurement (P < 0.05).
Table 3: Mean systolic and diastolic non-invasive blood pressure (mmHg) at various intervals

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[Table 4] shows that EtCO2 levels between the two groups did not differ significantly during induction and intubation. However, the EtCO2 was significantly higher in Group I at 10, 25, 30 and 35 min and similar at 5 and 40 min of post-operative measurement (P < 0.05).
Table 4: Mean end-tidal CO2 (mmHg) levels at various intervals

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[Table 5] shows that there was a significant delay in spontaneous eye opening, orientation, squeezing finger and lifting limb in sevoflurane group compared to desflurane group (P < 0.05). Post-operative nausea and vomiting was significantly low in desflurane group (P < 0.05). The present study observed significant higher visual analogue SCALE score of pain in sevoflurane group compared to desflurane group (P < 0.05).
Table 5: Recovery characteristics and post-operative complication in both groups

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  Discussion Top


Important requisites of modern-day anaesthesia are rapid emergence and post-operative recovery as well as haemodynamic stability.[10]

Our study found that there was no statistically significant difference between the two treatment groups with respect to gender, age, body weight, ASA classification and duration of surgery. In both groups, just before incision (anaesthetised patients awaiting stimulation), BP and HR demonstrated as expected decrease and the minimum values were recorded immediately before skin incision.

The present study observed that desflurane has better stability than sevoflurane regarding haemodynamic parameters such as HR, BP and EtCO2. These findings are similar with the similar study done by Fletcher et al.,[11] Shan et al.,[12] Magni et al.[13] and Nathanson et al.[4] However, some other similar studies done by White et al.,[14] Patel and Parmar [3] Gupta et al.,[15] Eberts and Schmid [7] Weiskopf et al.,[16] Kang et al.,[17] Kaur et al.,[18] Strum et al.[19] and Gergin et al.[6] observed no difference between haemodynamic parameters such as HR, BP and EtCO2.

Their results indicated that desflurane like isoflurane could maintain haemodynamic stability in concentrations producing surgical anaesthesia.[20] In another study, findings showed that desflurane might be more successful in controlling hypertensive responses than isoflurane.[21]

White et al.[14] found no difference in haemodynamics, emergence and recovery characteristics between sevoflurane and desflurane group. A similar study done by Ghouri et al.[22] suggested that the use of desflurane (vs. isoflurane) was associated with less depression of cognitive function during the early post-operative period.

Our study measured post-operative recovery profiles include the duration of opening eyes, orientation, squeezing finger and lifting limb and compared that duration between study groups. Hence, our study observed significant early recovery in desflurane group compared to sevoflurane group. These parameters are helpful to early discharge of patients in day-care surgeries. This observation is comparable with the study done by Kaur et al.,[18] Fletcher et al.,[11] Gergin et al.,[6] Bennett et al.[21] and Nathanson et al.[4] but not comparable with the similar study done by Romeo et al.,[23] La Colla et al.[24] and Vallejo et al.[25] where they did not find any difference between post-operative recovery parameters and complications.

The study done by Nathanson et al.[4] observed similar intraoperative conditions during the maintenance period between both the groups. Randomised, double-blind study of Tarazi and Philip [26] and Song et al.[27] found both the agents suitable for day-care surgeries.

Most frequent side effect after surgery was nausea and vomiting in our study. The incidence of these symptoms was significantly higher in the sevoflurane group. This finding is similar with the study done by Kaur et al.,[18] Larsen et al.[28] and Loop and Priebe.[29] This finding is not comparable with the similar study done by Gergin et al.,[6] Bennett et al.,[21] Grundman et al.,[30] Nathanson et al.,[4] Karlsen et al.,[31] Tarazi and Philip [26] and Song et al.[27]


  Conclusion Top


Our study concluded that desflurane has significant better haemodynamic stability during post-operative period compared to sevoflurane. Our study also observed better post-operative recovery and less post-operative complications amongst desflurane than sevoflurane. The more predictable and rapid recovery after desflurane might have a significant beneficial effect on post-operative morbidity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Patel M, Parmar N. Comparison of hemodynamic parameters and recovery characteristics between sevoflrane and desflrane in patients undergoing day care gynecological laparoscopic surgery. Int J Med Sci Public Health 2016;5:1412-6.  Back to cited text no. 3
    
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Nathanson MH, Fredman B, Smith I, White PF. Sevoflurane versus desflurane for outpatient anesthesia: A comparison of maintenance and recovery profiles. Anesth Analg 1995;81:1186-90.  Back to cited text no. 4
    
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Weiskopf RB, Moore MA, Eger EI 2nd, Noorani M, McKay L, Chortkoff B, et al. Rapid increase in desflurane concentration is associated with greater transient cardiovascular stimulation than with rapid increase in isoflurane concentration in humans. Anesthesiology 1994;80:1035-45.  Back to cited text no. 5
    
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Eberts TJ, Schmid PG. Inhaled anesthetics. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC, editors. Clinical Anesthesia. 6th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2009. p. 413-43.  Back to cited text no. 7
    
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Fletcher JE, Sebel PS, Murphy MR, Smith CA, Mick SA, Flister MP. Psychomotor performance after desflurane anesthesia: A comparison with isoflurane. Anesth Analg 1991;73:260-5.  Back to cited text no. 11
    
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Shan J, Sun L, Wang D, Li X. Comparison of the neuroprotective effects and recovery profiles of isoflurane, sevoflurane and desflurane as neurosurgical pre-conditioning on ischemia/reperfusion cerebral injury. Int J Clin Exp Pathol 2015;8:2001-9.  Back to cited text no. 12
    
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Magni G, Rosa IL, Melillo G, Savio A, Rosa G. A comparison between sevoflurane and desflurane anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth Analg 1995;81:118-90.  Back to cited text no. 13
    
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Gupta P, Rath GP, Prabhakar H, Bithal PK. Comparison between sevoflurane and desflurane on emergence and recovery characteristics of children undergoing surgery for spinal dysraphism. Indian J Anaesth 2015;59:482-7.  Back to cited text no. 15
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