Recovery of cognitive function after remifentanil-propofol anesthesia: A comparison with desflurane and sevoflurane anesthesia

We compared the recovery characteristics of remifentanil, desflurane, and s evoflurane when used for anesthesia in elective operative procedures. Sixty ASA physical status I and II patients, aged 18-65 yr, were randomly assign ed to receive remifentanil-propofol, desflurane-N2O, or sevoflurane-N2O ane sthesia. Before the induction of anesthesia, the patients of the desflurane and sevoflurane groups received fentanyl 2 mu g/kg. In all groups, anesthe sia was induced with propofol and maintained either with remifentanil 0.25 mu g.kg(-1).min(-1), desflurane, or sevoflurane 0.85 MAC with 65% nitrous o xide in oxygen. Anesthetics were titrated to achieve an adequate level of s urgical anesthesia and to maintain mean arterial pressure within 20% of bas eline values. Early recovery times and a modified Aldrete Recovery Score > 9 were recorded. Trieger Dot Test and Digit Substitution Test (DSST) were p erformed the day before surgery and in the postanesthesia care unit to eval uate intermediate recovery. The remifentanil-propofol group had a significa ntly faster emergence than desflurane or sevoflurane, with no difference be tween both inhaled anesthetics. Thirty min after anesthesia administration, patients in the remifentanil-propofol and in the desflurane groups gave si gnificantly more correct responses in the DSST compared with sevoflurane (r emifentanil 87%, desflurane 83%, sevoflurane 56%), the impairment in the se voflurane patients corresponding to the effects of a blood alcohol level. o f approximately 0.1% and, thus, being of clinical importance. Ninety minute s after anesthesia administration, no significant difference could be demon strated among the groups in the DSST scores. Emergence and return of cognit ive function was significantly faster after remifentanil-propofol compared with desflurane and sevoflurane up to 60 min after anesthesia administratio n. Implications: We compared awakening and intermediate recovery times afte r remifentanil-propofol anesthesia to desflurane-N2O and sevoflurane-N2O an esthesia. Emergence and return of cognitive function was significantly fast er after remifentanil-propofol compared with desflurane and sevoflurane up to 60 min after anesthesia administration.