Sevoflurane and Desflurane in Patients Undergoing Elective Neurosurgical Procedures

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Sevoflurane and Desflurane in Patients Undergoing Elective Neurosurgical Procedures

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Aim: The primary objective of the study was to compare the early post-operative recovery profile of Sevoflurane with Desflurane in adult patients undergoing elective neurosurgical procedures, with respect to emergence time, extubation time and the time taken to reach Aldrete score of 9. The secondary objectives were comparison of intra-operative hemodynamics, brain swelling, post-operative nausea and vomiting (PONV) and shivering. Methodology: After obtaining Institutional Ethical Committee (IEC) approval, 50 consenting adult patients posted for elective craniotomies were randomly allocated by computer generated random number technique into two groups, Group S (Sevoflurane) and Group D (Desflurane). Patients were preoxygenated and induced as per institution protocol. Patients were intubated with appropriate size endotracheal tube and anaesthesia was maintained with O 2: Air at 50%, chosen volatile anaesthetic that was age adjusted to obtain 1 MAC. Tidal volume and respiratory rate were adjusted to obtain an End tidal CO2 (EtCO2) of 30-35 mmHg. Normothermia was maintained with forced air warmer. When the duramater was opened, subjective assessment of brain swelling was done by the neurosurgeon, who was blinded to the study group. Infusions were stopped once the bone flap was secured and the volatile agent was discontinued after skin closure and detachment of Mayfield head holder. Patients were reversed and extubated after TOF ratio was > 0.9 and hemodyamics were stable. Intra-operative hemodynamics, brain swelling, emergence time, extubation time, time to reach Aldrete score of 9, PONV and shivering were recorded and patients were shifted to PostAnaesthesia Care Unit (PACU) for monitoring. Results: Statistical analysis was done using SPSS software. Descriptive statistics of mean and standard deviation were arrived for the variables wherever appropriate and Paired ‘t’ test, Chi-square test or Fischer’s test were used wherever appropriate to compare the mean difference between the variables to derive the p-value. A p-value of <0.05 was considered statistically significant. The Emergence time (Group S 8.28 ± 3.75 minutes vs. Group D 8.44 ± 3.98 minutes; p-value 0.885), Extubation time (Group S 11.84 ± 4.13 minutes vs. Group D 11.92 ± 5.01 minutes: p-value 0.959), time to reach Aldrete score of 9 (Group S 7.72 ± 4.2 minutes vs. Group D 6.2 ± 3.74 minutes: p-value 0.618) were statistically and clinically comparable. The secondary objectives of the study like intra-operative hemodynamics (MAP with p-value 0.977, HR with p-value 0.431), brain swelling (p-value 1.00), PONV (p-value 0.307) and shivering (p-value 1.00) were also comparable between two groups. Conclusion: We conclude that there was no statistically significant difference in early recovery profile between Sevoflurane and Desflurane in neurosurgical procedures with respect to emergence time, extubation time and time to reach Aldrete score of 9. There was no significant difference in intra-operative hemodynamics, incidence of postoperative nausea and vomiting, shivering and brain swelling between both the groups.

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