A comparison of the recovery profiles of desflurane and isoflurane anesthesia in patients undergoing elective supratentorial craniotomy: A randomized controlled trial

Paul, Aparanjit P; Vedantam, Aditya; Korula, Grace; Chacko, Ari G

doi:10.4103/neuroindia.ni_1136_15

Cited by 4 publications

(22 citation statements)

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“…These were significantly shorter in the desflurane group in comparison to those in the isoflurane group. In agreement with these findings, Paul et al, 22 found that desflurane significantly reduced emergence times, thereby facilitating an early neurological examination for patient. Kaye et al, 7 reported that neurosurgical patients when anesthetized with desflurane opened their eyes and obeyed commands 50% faster than those receiving isoflurane.…”

Section: Discussionmentioning

confidence: 57%

The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

Mandal¹,

Mukherjee²,

Acharjee³

et al. 2022

Asian J Med Sci

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Background: Preserving hemodynamic stability, providing a slack brain, and enabling early recovery are the main criteria of neuroanesthesia. The most commonly used volatile anesthetic for neurosurgeries is isoflurane due to its favorable effects on cerebral blood flow and intracranial pressure. On the other hand, desflurane, having lower blood gas partition coefficient, favors rapid recovery from anesthesia. Aims and Objectives: This study was conducted for comparing the effects of desflurane and isoflurane on intraoperative cerebral and cardiovascular hemodynamics and post-operative recovery among patients with supratentorial neoplasms posted for craniotomy. Materials and Methods: A total of 52 patients aged 20–60, ASA I and II, scheduled for craniotomy under general anesthesia, were randomized into Group I (isoflurane) and Group D (desflurane). All patients received standardized anesthetic protocol and anesthesia was maintained either with isoflurane or desflurane (≤1 MAC). Lumbar cerebrospinal fluid pressure (LCSFP) and cerebral perfusion pressure (CPP) were monitored every 5 min till dura was opened and the degree of dural tension and brain swelling were assessed by neurosurgeons, blinded to the study, at the time of dural opening. Perioperative heart rate, mean arterial pressure, and post-operative recovery time were also noted. Results: No statistically significant changes were observed among two groups regarding change in LCSFP, CPP, dural tension, brain swelling, and cardiovascular changes. Post-operative recovery time was significantly shorter in desflurane group (P<0.001) than isoflurane group. Conclusion: Desflurane and isoflurane both can be used safely in maintaining neuroanesthesia. However, due to a significantly faster recovery which facilitates early post-operative neurological assessment, desflurane may be considered a better alternative to isoflurane.

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Section: Discussionmentioning

confidence: 57%

The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

Mandal¹,

Mukherjee²,

Acharjee³

et al. 2022

Asian J Med Sci

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“…No study found statistically significant differences in brain relaxation scores between desflurane and the other anesthetic agents. Time to eye opening, defined as the time between cessation of the anesthetic agent and eye opening, was reported in 8 studies 9–12,14–17 . Anesthesia with desflurane resulted in significantly shorter times to eye opening in 5 of these 8 studies, 9,14–17 whereas there was no statistically significant differences in eye opening times among the other studies 10–12 .…”

Section: Resultsmentioning

confidence: 99%

“…The results of the primary outcomes are summarized in Table 2. Brain relaxation scores were reported in 5 studies 10,13–16 . For the evaluation of brain relaxation, a score ranging from 1 (completely relaxed brain) to 4 (swollen brain) was used in all studies.…”

Section: Resultsmentioning

confidence: 99%

“…For the purposes of this review, time to recovery was defined as the time from discontinuation of the anesthetic agent to patient orientation after verbal stimuli; shorter times to recovery associated with desflurane were reported in 5 studies, 9,11,15–17 whereas 2 studies reported no differences 10,14 . A clear and common definition of the time to follow commands was not available across the included studies; 3 studies reported time to follow commands 12,13,16 ; and 2 reported time to hand gripping 9,17 ; in the current review, time to hand gripping was considered the same as time to follow commands. In 4 of 5 studies, anesthesia with desflurane was associated with significantly shorter times to follow commands compared with other agents 9,13,16,17 .…”

Section: Resultsmentioning

confidence: 99%

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Clinical Effects and Adverse Events Associated With Desflurane Use in Adult Patients Undergoing Supratentorial Craniotomy: A Systematic Review

Gkantinas

Tataki

Lykoudis

et al. 2023

Journal of Neurosurgical Anesthesiology

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Desflurane is an inhalational anesthetic agent with an appealing recovery profile. The present systematic review investigates the clinical effects and adverse events associated with desflurane use during supratentorial craniotomy for brain tumor resection in adults in comparison with other inhalational and intravenous anesthetic agents. A literature search was conducted across the MEDLINE, Library of Congress and LISTA (EBS-CO) databases from January 2001 to January 2021. Twelve studies published between 2003 and 2020 were included in this systematic review. Desflurane was compared with either isoflurane, sevoflurane, or propofol for anesthesia maintenance. Brain relaxation scores showed no statistically significant difference between desflurane and the other anesthetic agents. Recovery timepoints, such as time to recovery, time to eye opening, time to extubation, time to follow commands, and time to reach a modified Aldrete score ≥ 9 were significantly shorter with desflurane in the majority of studies. Systemic hemodynamic variables (mean arterial pressure and heart rate) and cerebral hemodynamics (intracranial pressure and cerebrospinal fluid pressure) were comparable between desflurane and other anesthetic agents in each study. The results of this systematic review demonstrate that desflurane is associated with few adverse events when used for anesthesia maintenance in adult patients undergoing supratentorial brain tumor surgery. Large, prospective, comprehensive studies, utilizing standardized parameter evaluation could provide higher levels of evidence to support these findings.

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“…We intended to include minimum 50 patients in our study as per study by Paul et al [7] to have a statistical power of…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Emergence Characteristics, Intraoperative Haemodynamics and Intraoperative Brain Relaxation between Isoflurane and Desflurane in Patients Undergoing Craniotomy for Supratentorial Lesions.

Chahar

Dubey

Rai

et al. 2019

AAN

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Background: Desflurane had increased anaesthetic armamentarium for maintenance of general anesthesia in neurosurgical cases. Few studies have compared isoflurane and desflurane for patients undergoing elective supratentorial craniotomy. Aims: The aim of this study is to compare emergence characteristics, intraoperative haemodynamic and intraoperative brain relaxation between isoflurane and desflurane in patients undergoing craniotomy for supratentorial lesions. Settings and Design: Prospective randomized and comparative study. Subjects and Methods: In this study, patients were randomly allocated in two groups. Groups I and D received Isoflurane and desflurane in MAC (0.8-1.2) during maintenance of general anesthesia after endotracheal intubation till skin closure. Emergence time, Extubation time, perioperative hypertension and intraoperative brain relaxation was compared between 2 groups across different time period. Statistical Analysis: Mean and standard deviation were calculated. Test of analysis between two groups was done by t-test and then P value was calculated. Results: Significantly lesser emergence time and extubation time in group D compared to group I (7.53±2.11 vs 15.10±1.7 and 10.87±1.961 vs 18.20±1.92). Perioperative haemodynamics were among comparable between both groups. Intraoperative brain relaxation was also comparable between 2 groups with more patients in desflurane group having grade 1 relaxation. Incidence of emergence hypertension and post-operative complication were also similar with 2 groups. Conclusion: It is concluded from the study that both inhalational agents isoflurane and desflurane can be used in patients undergoing supratentorial surgeries, desflurane has added advantage of faster post-operative recovery and intraoperative brain relaxation and emergence characteristics.

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A comparison of the recovery profiles of desflurane and isoflurane anesthesia in patients undergoing elective supratentorial craniotomy: A randomized controlled trial

Abstract: Desflurane significantly reduced emergence times, and was able to facilitate an early neurological examination for patients. Additional studies are required to establish the impact of inhalational agents on transient postoperative neurological deficits.

Cited by 4 publications

References 1 publication

The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

The comparative effects of desflurane and isoflurane on intraoperative cerebral hemodynamics, cardiovascular changes, and post-operative recovery in patients undergoing craniotomy for supratentorial tumors

Clinical Effects and Adverse Events Associated With Desflurane Use in Adult Patients Undergoing Supratentorial Craniotomy: A Systematic Review

A Comparison of Emergence Characteristics, Intraoperative Haemodynamics and Intraoperative Brain Relaxation between Isoflurane and Desflurane in Patients Undergoing Craniotomy for Supratentorial Lesions.

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