Hemodynamics and early recovery characteristics of desflurane versus sevoflurane in bariatric surgery

Abstract

Context: Morbidly obese patients are prone for intraoperative hemodynamic disturbances and postoperative airway complications. Aim: Comparison of intraoperative hemodynamics and postoperative recovery characteristics of desflurane versus sevoflurane in morbidly obese patients undergoing laparoscopic bariatric surgery. Settings and Design: Randomized controlled trial Materials and Methods: After institutional ethics committee approval and written informed consent, 40 morbidly obese patients (BMI > 35 kg/m 2 ) were randomized to receive desflurane or sevoflurane as part of a standardized general anesthesia technique. Volatile anesthetic concentration was titrated to maintain electroencephalographic bispectral index score (BIS) in the range of 40-60. Mean arterial pressure (MAP) and heart rate (HR) were recorded preoperatively, at induction and intubation, then at regular intervals. After extubation, early recovery was recorded by time to emergence and orientation to time and place. In post anesthesia care unit, intermediate recovery was assessed by modified Aldrete Score and Digit Symbol Substitution Test (DSST). Results: Intraoperative MAP and HR did not differ between the two groups ( P > 0.05). The time to response to painful stimuli, obeying verbal commands and spontaneous eye opening was shorter ( P = 0.001) and modified Aldrete Score was higher after desflurane anesthesia than after sevoflurane anesthesia ( P = 0.049). DSST also returned towards normal faster after desflurane (28.50 ± 6.30 min vs. 35.0 ± 5.62 min, P = 0.03). Conclusions: Both desflurane and sevoflurane produce similar hemodynamic changes but the immediate and intermediate recovery was significantly faster after desflurane thus contributing to fast tracking and early discharge of patients.

Keywords

• Anesthesia
• morbidly obese
• anesthetics volatile
• sevoflurane
• desflurane
• recovery
• early
• intermediate