Beaussier1998 Article ComparativeEffectsOfDesflurane
Beaussier1998 Article ComparativeEffectsOfDesflurane
Comparative effects of
Marc Beaussier MD, desflurane and isoflurane
Hugues Deriaz MD,
Zoubida Abdelahim MD, on recovery after long
Feti Aissa MD,
Andr~ Lienhart MD lasting anaesthesia
Purpose: Increasing the duration of exposure could lead to amplification of the pharmacokinetic differences
between halogenated anaesthetic agents. The aim of our study was to compare anaesthesia recovery after desflu-
rane and isoflurane, administered for more than three hours.
Methods: After informed consent, patients were randomly assigned to either desflurane (n = 15) or isoflurane
(n = IS) groups. At the end of surgery, halogenated agents were discontinued and fresh gas flow was increased
to 6 l'min -I oxygen 100%.
Results: Mean anaesthesia duration was 292 - 63 and 304 --+ 91 rain in the desflurane and isoflurane groups
respectively. After desflurane and isoflurane discontinuation, the time to opening eyes was 12 _+ 7 and 24 ___I I rain
respectively (P < 0.001 ); to squeeze fingers at command was 17 _ I I and 35 __- 19 rain (P < 0.001); to extuba-
tion was 16 ___6 and 33 __+ 13 rain (P < 0.001); to give their name was 2_2 ___ 12 and 43 ___21 rain (P < 0.001);
to achieve a Steward score of 6 was 28 - 16 and 57 --- 33 rain (P < 0.001 ), to be fCcfor discharge from the recov-
ery room was 46 __. 19 and 81 +_ 37 rain (P < 0.003). Ranges of times to reappearance of recovery variables in
the desflurane group were less than those after isoflurane (P < 0.0S).
Conclusion: After long duration anaesthesia lasting up to three hours, desflurane allowed recovery and extu-
bation in approximately half the time required by isoflurane. Less variability in results suggests better predictabili-
ty of recovery with desflurane.
O b j e c d f : Les differences pharmacodynamiques entre les agents halogen& sont amplifi&s par la durEe
d'administration. Ce travail compare les param&res de rEveil aprEs une anesthEsie sup&ieure fi trois heures avec
de riso-flurane ou du desflurane.
M & h o d e : AprEs consentement Eclair& les patients ont &E rEpartis par tirage au sort pour recevoir de }'isoflu-
rane (n = 15) ou du desflurane (n = I S). Au demier point de suture cutanEe, l'administration d'agent halogEnE
Etait stoppEe et le debit de gaz frais porte ~ 6 l'min -~ d'oxygEne.
R~sultats : La durEe d'anesth&ie a ErE de 292 ___63 et 304 _ 91 rain pour le desflurane et l'isoflurane respec-
tivement. Le dElai pour rouverture des yeux a EtE de 12 --- 7 et 24 + I I min (P < 0.001); pour setter les mains
~. la demande de 17 -_- I I et 35 --- 19 rain (P < 0.001); pour l'extubationde 16 - 6 et 33 --+ 13 rain (P < 0.001);
pour donner son nora de 22 - 12 et 43 __. 21 rain (P < 0.001); pour r&up&er un score de Steward ~ 6 de 28
_ 16 et 57 --- 33 min (P < 0.001); pour avoir l'autorisation de sortie de salle de rEveil de 46 ___ 19 et 81 _ 37 rain
(P < 0.003) pour le desflurane et risoflurane respectivement.
Conclusion : AprEs une anesthEsie supErieure ~ trois heures, le desflurane permet un rEveil et une extubation
approximativement deux fois plus rapide que l'isoflurane. La plus faible variabilitE des valeurs suggEre une
meilleure prEdictibilitE des param&res de rEveil avec le desflurane.
From the D6partement d'Anesth6sie-l~animation chirurgicale, H6pital St-Antoine, 184 rue du Fg St-Antoine, 75571 Paris C6dex 12, France.
Supported by a grant from Pharmacia France, St Quentin-Yvelyne, France.
Address correspondenceto: Dr. Marc Beaussier; Phone: 33-1-4928-2000; Fax: 33-1-4928-2826.
Acceptedfor publication January 31, 1998.
HE new volatile anaesthetic agent desflu- agogastroplasty (n = 1), repair of rectal prolapse (n = 1),
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anaesthesia was then maintained with nitrous oxide until It has been suggested that rapid elimination ofhalo-
the end of skin closure. The time between halogenated genated agent may increase the occurence and severity
agents and nitrous oxide discontinuation was unknown of shivering, secondary to the sudden recovery of ther-
and no comparative tests of these data were applied. moregulatory mechanisms.27 In our study, intraopera-
Although this methodology corresponds to common five heat loss was reduced with forced-air warming
clinical practice, the lack of uniformity in the study blankets. Only half the patients experienced shivering,
design could be an explanation of the discrepancies with which was always of short duration. No difference was
our conclusions. In our study, halogenated agents were observed between desflurane and isoflurane concerning
stopped concurrently to nitrous oxide in all patients at the occurence, duration and severity of shivering.
the end of surgical procedure. Furthermore, in Azad's Time to be fitness for discharge from the recovery
study, recovery was assessed only as the time until room was faster with desflurane than with isoflurane.
patients responded to verbal commands. No informa- Time for effective discharge was similar, probably
tion was given for time to extubation. In our study, we because of extra-anaesthetic factors. One explanation is
focused on immediate and intermediate recovery para- that the fast recovery obtained with the new agent des-
meters. Steward score evaluates grade of consciousness, flurane was unusual for the recovery room nursing team
ability to maintain airway and moving.22 This score had who were blinded to the agent used. Cost-saving relative
been chosen because it is easy to perform and it repre- to the potential ability to decrease the stay in recovery
sents a series of progressive changes directly related to room with desflurane should be compared with the
the recovery process. Rapid initial recovery may increase greater expenditure relative to its administration. Low-
airway protection after tracheal extubation in the recov- flow anaesthesia is recommended during long lasting
ery room. Improving intermediate recovery parameters administration of halogenated agents and has been esti-
(such .as response to command and the ability to talk) is mated to provide important reduction of anaesthetic
also of major importance because, at this time, patients consumption.2s
are often less supervised and good awakening could lead In conclusion, prolonged anaesthesia of more than
to improved management of the postoperative period three hours highlights the pharmacodynamic properties
(e.g., better evaluation of postoperative pain). In addi- of desflurane. Recovery parameters, extubation and time
tion to faster recovery, we demonstrated less variability to fitness for discharge from the recovery room with des-
of the time to awakening in the desflurane group. Better flurane were approximatively half those with isoflurane.
predictability of recovery after long lasting anaesthesia In addition, the variability of times to awakening in the
could be consider as a safety argument for desflurane. desflurane group was less than with isoflurane, suggesting
I--Ialogenated anaesthetic consumption during the that recovery is more predictable with desflurane.
procedure may influence the time to recovery. Total
consumption, estimated by the area under the curve Appendix I
of end-tidal concentration throughout the course of Lorentz formula
the procedure, expressed as MAC fraction, was less Ideal weight for men (kg) = height (cm) - 100 - height - 150
with desflurane than with isoflurane. Halogenated 4
end-tidal concentrations were adjusted to obtain an Ideal weightfor women (kg) = height (cm)- 100- height- 150
adequate level of anaesthesia and blood pressure sta- 2
bility. Haemodynamic profiles were similar between
the two groups. Moreover, the effects of fentanyl on Appendix I I
the reduction of halogenated MAC are similar for
Steward score
desflurane and isoflurane.26 Explanations of the dif-
Consciousness
ference in consumption are unclear. As the MAC
Awake 2
value decreases with age, especially for desflurane, it is
Reponding to stimuli 1
possible that MAC in the patients over 65 years old
Not reponding 0
have been a little overestimated and misled our
results. Nevertheless, it is unlikely that such difference Airway
in anaesthetic consumption could explain our results. Coughing on command or crying 2
Furthermore, at the time we stopped halogenated Maintening good airway 1
administration, end-tidal concentration, converted to Airway requires maintenance 0
fractional MAC, did not differ between the two Movement
groups. Both received the same doses of fentanyl and Moving limbs purposefully 2
residual neuromuscular blockade was antagonised if Non-purposeful movements 1
needed. Not moving 0
434 CANADIAN JOURNAL OF ANAESTHESIA