The recovery of cognitive function after general anesthesia in elderly patients: A comparison of desflurane and sevoflurane

Citation
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
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Aneshtesia & Intensive Care","Medical Research Diagnosis & Treatment
Journal title
ANESTHESIA AND ANALGESIA
ISSN journal
0003-2999 → ACNP
Volume
93
Issue
6
Year of publication
2001
Pages
1489 - 1494
Database
ISI
SICI code
0003-2999(200112)93:6<1489:TROCFA>2.0.ZU;2-P
Abstract
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.