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GENERAL ARTICLES

Emergence and Recovery Characteristics of Desflurane Versus Sevoflurane in Morbidly Obese Adult Surgical Patients: A Prospective, Randomized Study

Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, California.

Address correspondence and reprint requests to Earl M. Strum, MD, Department of Anesthesiology, University Hospital, 1500 San Pablo Street 4th floor, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033. Address e-mail to earl.strum{at}tenethealth.com

We compared postoperative recovery after desflurane (n = 25) versus sevoflurane (n = 25) anesthesia in morbidly obese adults (body mass index 35) who underwent gastrointestinal bypass surgery via an open laparotomy. After premedication with midazolam and metoclopramide 1 h before surgery, epidural catheter placement, induction of anesthesia with fentanyl and propofol, and tracheal intubation facilitated with succinylcholine, anesthesia was maintained with age-adjusted 1 minimum alveolar concentration (MAC) desflurane or sevoflurane. Fentanyl IV, morphine or local anesthetics epidurally, and vasoactive drugs as needed were used to maintain arterial blood pressure at ±20% of baseline value and to keep bispectral index of the electroencephalogram values between 40 to 60 U. Although patients were anesthetized with desflurane for a longer time (261 ± 50 min versus 234 ± 37 min, mean ± SD; P < 0.05, desflurane versus sevoflurane, respectively) and for more MAC-hours (4.2 ± 0.9 h versus 3.7 ± 0.8 h; P < 0.05), significantly earlier recovery of response to command and tracheal extubation occurred in patients given desflurane than in patients given sevoflurane. The modified Aldrete score was greater in desflurane-anesthetized patients on admission to the postanesthesia care unit (PACU) (P = 0.01) but not at discharge (P = 0.47). On admission to PACU, patients given desflurane had higher oxygen saturations (97.0% ± 2.4%) than patients given sevoflurane (94.8% ± 4.4%, P = 0.035). Overall, the incidence of postoperative nausea and vomiting and the use of antiemetics did not differ between the two anesthetic groups. We conclude that morbidly obese adult patients who underwent major abdominal surgery in a prospective, randomized study awoke significantly faster after desflurane than after sevoflurane anesthesia and the patients anesthetized with desflurane had higher oxygen saturation on entry to the PACU.

IMPLICATIONS: Morbidly obese adult patients who underwent major abdominal surgery in a prospective, randomized study awoke significantly faster after desflurane than after sevoflurane anesthesia, and the patients anesthetized with desflurane had higher oxygen saturations on entry to the postanesthesia care unit.

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