SEVOFLURANE VERSUS DESFLURANE FOR OUTPATIENT ANESTHESIA - A COMPARISON OF MAINTENANCE AND RECOVERY PROFILES

The recovery characteristics of desflurane and sevoflurane were compar ed when used for maintenance of ambulatory anesthesia. After obtaining informed consent, 42 healthy, unpremedicated women undergoing laparos copic sterilization procedures were studied. Anesthesia was induced wi th propofol, 1.5-2.0 mg/kg, and maintained with either desflurane 3%-6 % (n = 21) or sevoflurane 1%-2% (n = 21) with 60% nitrous oxide in oxy gen. Intraoperative analgesia and neuromuscular block was achieved usi ng fentanyl and vecuronium, respectively. The inhaled anesthetics were titrated to achieve an adequate clinical ''depth of anesthesia'' and to maintain mean arterial pressure (MAP) within 20% of the preinductio n baseline values. Visual analog scales (VAS) and the digit-symbol sub stitution test (DSST) were performed preoperatively and at 30-min inte rvals during the recovery period. There were no differences between th e two groups in the total doses of propofol, fentanyl, or vecuronium. Heart rate (HR) values were lower in the sevoflurane group during the induction-to-incision period. However, HR and MAP were otherwise simil ar during the maintenance and recovery periods. Use of desflurane led to a more rapid emergence (4.8+/-2.4 vs 7.8+/-3.8 min) and shorter tim e to extubation (5.1+/-2.2 vs 8.2+/-4.2 min) compared to sevoflurane ( mean values +/- so). Intermediate recovery times, postoperative VAS an d DSST scores, and side effects were similar in the two treatment grou ps. Although sevoflurane was associated with a slower emergence from a nesthesia than desflurane after laparoscopic surgery, recovery of cogn itive function and discharge times were similar in the two anesthetic groups. Thus, it would appear that sevoflurane is an acceptable altern ative to desflurane for maintenance of outpatient anesthesia. However, the phar macoeconomic impact (if any) of the slower emergence with se voflurane is yet to be determined.