Comparison of Recovery Profile of Propofol, Sevoflurane, and Desflurane Anesthesia in Transnasal Trans-sphenoidal Surgery for Pituitary Tumors: A Prospective Randomized Trial

Abstract

Background Smooth and early emergence is always a concern in neurosurgical patients as it prevents complication and facilitates neurological examination and immediate postoperative intervention, if necessary. Methods A prospective randomized trial was conducted to evaluate the effects of propofol, sevoflurane, and desflurane used for maintenance of anesthesia at the time of emergence and recovery from anesthesia in 75 patients undergoing elective trans-sphenoidal surgery for pituitary tumors. We evaluated time for emergence and extubation, modified Short Orientation Memory Concentration Test (SOMCT) score, Aldrete's scores, pain score, and postoperative nausea and vomiting (PONV) score. Results Emergence and extubation times were significantly shorter in patients receiving desflurane as compared with those receiving propofol or sevoflurane (p < 0.001). Modified SOMCT and Aldrete's scores were comparable in all the three groups with better cognitive scores in patients who received desflurane. Heart rate and mean arterial pressure were comparable at emergence and extubation in all the three groups except mean airway pressure (MAP) at extubation that was higher in the desflurane group compared with propofol and sevoflurane groups (p = 0.02), which was clinically comparable. Pain and PONV scores were also comparable between the groups. Conclusions Desflurane had shorter time to emergence and time to extubation in comparison to propofol and sevoflurane. Thus, desflurane can be used as an alternative to propofol and sevoflurane for maintenance of anesthesia in patients undergoing transnasal trans-sphenoidal pituitary surgery for its excellent recovery profile after anesthesia.

Keywords

• desflurane
• emergence
• propofol
• sevoflurane
• trans-sphenoidal pituitary surgery