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ANESTHETIC PHARMACOLOGY

The Recovery of Cognitive Function After General Anesthesia in Elderly Patients: A Comparison of Desflurane and Sevoflurane

Xiaoguang Chen, MD^*, Manxu Zhao, MD^*, Paul F. White, PhD MD, FANZCA^*, Shitong Li, MD^*, Jun Tang, MD^*, Ronald H. Wender, MD, Alexander Sloninsky, MD, Robert Naruse, MD, Robert Kariger, MD, Tom Webb, MD, and Eve Norel, MD

*Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas; and Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California

Address all correspondence to Dr. Paul F. White, Professor and McDermott Chair of Anesthesiology, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, F2.208, Dallas, Texas 75390-9068. Address e-mail to paul.white{at}utsouthwestern.edu

We evaluated the cognitive recovery profiles in elderly patients after general anesthesia with desflurane or sevoflurane. After IRB approval, 70 ASA physical status I–III consenting elderly patients (65 yr old) undergoing total knee or hip replacement procedures were randomly assigned to one of two general anesthetic groups. Propofol and fentanyl were administered for induction of anesthesia, followed by either desflurane 2%–4% or sevoflurane 1%–1.5% with nitrous oxide 65% in oxygen. The desflurane (2.5 ± 0.6 MAC · h) and sevoflurane (2.7 ± 0.5 MAC · h) concentrations were adjusted to maintain comparable depths of hypnosis using the electroencephalogram 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 more 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 min versus 241 ± 87 min). However, there were no significant differences between the Desflurane and the Sevoflurane groups when the MMS scores were compared preoperatively, and postoperatively at 1, 3, 6, and 24 h. Compared with the preoperative (baseline) MMS scores, the values were significantly decreased at 1 h postoperatively (27.8 ± 1.7 versus 29.5 ± 0.5 in the Desflurane group, and 27.4 ± 1.7 versus 29.2 ± 1.0 in the Sevoflurane group, respectively). However, the MMS scores returned to preoperative baseline 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) Group experienced cognitive impairment. In conclusion, desflurane is associated with a faster early recovery than sevoflurane after general anesthesia in elderly patients. However, recovery of cognitive function was similar after desflurane and sevoflurane-based anesthesia.

IMPLICATIONS: Desflurane was associated with a faster early recovery than sevoflurane after general anesthesia in elderly patients. However, recovery of cognitive function was similar with both volatile anesthetics.

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