Xg. Chen et al., The recovery of cognitive function after general anesthesia in elderly patients: A comparison of desflurane and sevoflurane, ANESTH ANAL, 93(6), 2001, pp. 1489-1494
Citations number
30
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
We evaluated the cognitive recovery profiles in elderly patients after gene
ral anesthesia with desflurane or sevoflurane. After IRB approval, 70 ASA p
hysical status I-III consenting elderly patients (greater than or equal to
65 yr old) undergoing total knee or hip replacement procedures were randoml
y assigned to one of two general anesthetic groups. Propofol and fentanyl w
ere administered for induction of anesthesia, followed by either desflurane
2%-4% or sevoflurane 1%-1.5% with nitrous oxide 65% in oxygen. The desflur
ane (2.5 +/- 0.6 MAC . h) and sevoflurane (2.7 +/- 0.5 MAC - h) concentrati
ons were adjusted to maintain comparable depths of hypnosis using the elect
roencephalogram bispectral index monitor. The Mini-Mental State (MMS) test
was used to assess cognitive function preoperatively and postoperatively at
1, 3,6, and 24-h intervals. The use of desflurane was associated with a mo
re rapid emergence from anesthesia (6.3 +/- 2.4 min versus 8.0 +/- 2.8 min)
and a shorter length of stay in the postanesthesia care unit (213 +/- 66 m
in versus 241 +/- 87 min). However, there were no significant differences b
etween the Desflurane and the Sevoflurane groups when the MMS scores were c
ompared preoperatively, and postoperatively at 1, 3,6, and 24 h. Compared w
ith the preoperative (baseline) MMS scores, the values were significantly d
ecreased at 1 h postoperatively (27.8 +/- 1.7 versus 29.5 +/- 0.5 in the De
sflurane group, and 27.4 +/- 1.7 versus 29.2 +/- 1.0 in the Sevoflurane gro
up, respectively). However, the MMS scores returned to preoperative baselin
e levels within 6 h after surgery. At 1 h and 3 h after surgery, 51% and 11
% (versus 57% and 9%) of patients in the Desflurane (versus Sevoflurane) Gr
oup experienced cognitive impairment. In conclusion, desflurane is associat
ed with a faster early recovery than sevoflurane after general anesthesia i
n elderly patients. However, recovery of cognitive function was similar aft
er desflurane and sevoflurane-based anesthesia.