Abstract

Context: It is clear that the number of elderly is going to rise in coming days. Hence, number of elderly requiring surgery and anesthesia is also on increase. At the same time, there are newer developments in the field of anesthesia. Hence, operation theatre staff and doctors should know which agent is better when given the choice.

Aim: To compare recovery and postoperative cognitive functions after general anesthesia with sevoflurane or desflurane based technique in elderly patients.

Settings and Design: Prospective Randomized Controlled Comparative Interventional study was conducted at KIMS Hospital, Kondapur, Hyderabad.

Methods: 120 patients undergoing surgeries under general anesthesia were included. They were randomly assigned in two groups of 60 each; with one group receiving Sevoflurane and the other desflurane. Two groups were compared for different parameters.

Statistical Analysis: Chi Square Test was applied for categorical data and t test for the continuous data.

Results: Both the groups were comparable in terms of age and sex. Mean BMI was significantly higher in desflurane group compared to sevoflurane group (p < 0.05). Mean duration was significantly higher in desflurane group cases. The recovery indices were significantly better in desflurane group cases (p<0.05). MMSE scores were not significantly different in two groups (p>0.05). Incidence of POCD in two groups was comparable (p>0.05).

Conclusion: Both the drugs i.e. desflurane and sevoflurane are equally effective among elderly cases undergoing surgery under general anesthesia in preventing POCD.

Key messages: Desflurane and sevoflurane can be used in elderly patients undergoing surgery under general anesthesia.

• 1.   Monk TG, Price CC. Postoperative cognitive disorders. Curr Opin Crit Care 2011; 17: 376–381.
• 2.   Moller JT, Cluitmans P, Rasmussen LS. Longterm postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators. International Study of Post-Operative Cognitive Dysfunction. Lancet 1998; 351: 857–861.
• 3.   Chen PL, Yang CW, Tseng YK, Sun WZ, Wang JL, Wang SJ et al. Risk of dementia after anaesthesia and surgery. Br J Psychiatr 2014 Mar; 204(3):188-93.
• 4.   Wang W, Wang Y, Wu H, Lei L, Xu S, Shen X et al. Postoperative cognitive dysfunction: current developments in mechanism and prevention. Medical Science Monitor: Int Med J Exp Clin Res 2014; 20:1908.
• 5.   Davison LA, Steinhelber JC, Eger II, Stevens WC. Psychological effects of halothane and isoflurane anesthesia. J Am Soc Anesthesiologists. 1975 Sep 1; 43(3):313-24.
• 6.   Tsai SK, Lee C, Kwan WF, Chen BJ. Recovery of cognitive functions after anaesthesia with desflurane or isoflurane and nitrous oxide. BJA: Br J Anesth 1992 Sep 1; 69(3):255-8.
• 7.   Deepak TS, Vadlamani S, Kumar KS, Kempegowda P. Post-operative cognitive functions after general anesthesia with sevoflurane and desflurane in South Asian elderly. Middle East J Anesthesiol. 2013 Jun 1; 22(2):143-8.
• 8.   Heavner JE, Kaye AD, Lin BK, King T. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anesth 2003 Oct 1; 91(4):502-6.
• 9.   Tachibana S, Hayase T, Osuda M, Kazuma S, Yamakage M. Recovery of postoperative cognitive function in elderly patients after a long duration of desflurane anesthesia: a pilot study. J Anesth 2015 Aug; 29(4):627-30.
• 10.   Rörtgen D, Kloos J, Fries M, Grottke O, Rex S, Rossaint R, Coburn M. Comparison of early cognitive function and recovery after desflurane or sevoflurane anaesthesia in the elderly: a doubleblinded randomized controlled trial. British journal of anaesthesia. 2010 Feb 1;104(2):167-74.
• 11.   Choubey RK, Bhushan K, Singh G, Kulkarni SN, Honwad M, Yadav R. Recovery from desflurane and sevoflurane anaesthesia after prolonged surgery – A comparative study using Index of Consciousness (IoC) monitoring. Indian J Clin Anesth 2021; 8(1):68- 73.
• 12.   Johnson T, Monk T, Rasmussen LS. ISPOCD2 Investigators: postoperative cognitive dysfunction in middle-aged patients. Anesthesiology 2002; 96:1351–1357
• 13.   Pensado Castiñeiras A, Rama Maceiras P, Molins Gauna N, Fiqueira Moure A, Vásquez Fidalgo A. Immediate anesthesia recovery and psychomotor function of patient after prolonged anesthesia with desflurane, sevoflurane or isoflurane. Rev Esp Anestesiol Reanim. 2000 Nov;47(9):386-92
• 14.   Heavner JE, Kaye AD, Lin BK, King T. Recovery of elderly patients from two or more hours of desflurane or sevoflurane anaesthesia. Br J Anaesth (2003) ; 91 (4): 502-6
• 15.   Chen X, Zhao M, White PF, Li S, Tang J, Wender RH et al. The recovery of cognitive function after general anesthesia in elderly patients: a comparison of desflurane and sevoflurane. Anesth Analg 2001 Dec 1; 93(6):1489-94.
• 6.   Rörtgen D, Kloos J, Fries M, Grottke O, Rex S, Rossaint R et al. Comparison of early cognitive function and recovery after desflurane or sevoflurane anaesthesia in the elderly: a doubleblinded randomized controlled trial. Br J Anesth 2010 Feb 1;104(2):167-74.
• 17.   Jindal R, Kumra VP, Narani KK, Sood J. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian J Anesth 2011 Jan;55(1):36-42
• 18.   Abildstrom H, Rasmussen LS, Rentowl P. Cognitive dysfunction 1–2 years after non-cardiac surgery in the elderly. Acta Anaesthesiol Scand 2000;44:1246– 51.
• 19.   Deepak TS, Vadlamani S, Kumar KS, Kempegowda P. Post-operative cognitive functions after general anesthesia with sevoflurane and desflurane in South Asian elderly. Middle East J Anesthesiol. 2013 Jun 1;22(2):143-8.
• 20.   Baliarsing L, Gore M, Teckchandani D. Comparision of early cognitive recovery in patients undergoing elective abdominal surgeries using sevoflurane versus desflurane. Int J Contemporary Med Res 2016;3(7):1924-1927.

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