AWAKENING CHARACTERISTICS AND RECOVERY OF COGNITIVE FUNCTION IN PATIENTS UNDERGOING SHORT SURGICAL PROCEDURES: COMPARISON BETWEEN DESFLURANE AND PROPOFOL

FERNAZ BASHA; PARTHASARATHY S; ANTONY JOHN CHARLES S; RAVISHANKAR M; HEMANTH KUMAR VR

doi:10.22159/ajpcr.2021.v14i11.43089

Authors

FERNAZ BASHA Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillaiyarkuppam, Puducherry, India.
PARTHASARATHY S Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillaiyarkuppam, Puducherry, India.
ANTONY JOHN CHARLES S Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillaiyarkuppam, Puducherry, India.
RAVISHANKAR M Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillaiyarkuppam, Puducherry, India.
HEMANTH KUMAR VR Department of Anaesthesiology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth Deemed to be University, Pillaiyarkuppam, Puducherry, India.

DOI:

https://doi.org/10.22159/ajpcr.2021.v14i11.43089

Keywords:

Desflurane, Propofol, Awakening, Recovery, Cognitive function

Abstract

Objectives: Early awakening and recovery of the cognitive function improves post-operative outcome and early discharge of the patients. Desflurane and Propofol offer rapid emergence from anesthesia. We compared the awakening and recovery of cognitive function between these two agents.

Methods: A total of 50 patients aged 30–60 years belonging to ASA 1 and 2 were studied. In both the groups baseline, Mini Mental State Examination (MMSE) score was recorded and were induced with Target controlled infusion (TCI) of Propofol to achieve plasma site concentration (Cp) of 6 mcg/ml. Group P continued with TCI Propofol Cp 3 mcg ml-1 and in group D, TCI was stopped and started Desflurane 6% end tidal concentration followed by Desflurane 3%. Hemodynamic variables were noted and after stopping the agent, time to eye open, squeeze hands, removal of laryngeal mask airway, state name, and modified Aldrete score were noted. MMSE score was recorded 1, 6, and 24 h postoperatively.

Results: Awakening time was significantly shorter in duration in Desflurane group compared to Propofol. The mean time to eye open in the Propofol group was 10.41±2:31 min and Desflurane group was 06.21±01.42 min (***p=0.000). There was an increase in the mean MMSE score postoperatively at 6 h and 24 h interval when compared to the baseline within the groups. However, there was no difference in recovery of cognitive function between the two groups.

Conclusion: The use of inhalational agent Desflurane provided shorter awakening time than intravenous Propofol in short surgical procedures but the recovery of cognitive function was comparable. There were no significant side effects.

Downloads

Download data is not yet available.

References

Tang J, White PF, Wender RH, Naruse R, Kariger R, Sloninsky A, et al. Fast-track office-based anesthesia: A comparison of propofol versus desflurane with antiemetic prophylaxis in spontaneously breathing patients. Anesth Analg 2001;92:95-9.

Bailey CR, Ahuja M, Bartholomew K, Bew S, Forbes L, Lipp A, et al. Guidelines for day‐case surgery 2019. Anaesthesia 2019;74:778-92.

Ashworth J, Smith I. Comparison of desflurane with isoflurane or propofol in spontaneously breathing ambulatory patients. Anesth Analg 1998;87:312-8.

Lebenbom-Mansour MH, Pandit SK, Kothary SP, Randel GI, Levy L. Desflurane versus propofol anesthesia: A comparative analysis in outpatients. Anesth Analg 1993;76:936-41.

Graham SG, Aitkenhead AR. A comparison between propofol and desflurane anaesthesia for minor gynaecological laparoscopic surgery. Anaesthesia 1993;48:471-5.

Ebert JE, Lindenbaum. Inhaled Anaesthetics. In: Barash G, editor. Clinical Anesthesia. 7th ed. New Delhi: Wolters Kluwer; 2013. p. 452.

Chen G, Zhou Y, Shi Q, Zhou H. Comparison of early recovery and cognitive function after desflurane and sevoflurane anaesthesia in elderly patients: A meta-analysis of randomized controlled trials. J Int Med Res 2015;43:619-28.

Larsen B, Seitz A, Larsen R. Recovery of cognitive function after remifentanil-propofol anesthesia: A comparison with desflurane and sevoflurane anesthesia. Anesth Analg 2000;90:168-74.

Wrigley SR, Fairfield JE, Jones RM, Black AE. Induction and recovery characteristics of desflurane in day case patients: A comparison with propofol. Anaesthesia 1991;46:615-22.

Juvin P, Vadam C, Malek L, Dupont H, Marmuse JP, Desmonts JM. Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: A prospective, randomized study. Anesth Analg 2000;91:714-9.

Servin F, Farinotti R, Haberer JP, Desmonts JM. Propofol infusion for maintenance of anesthesia in morbidly obese patients receiving nitrous oxide a clinical and pharmacokinetic study. J Am Soc Anesthesiol 1993;78:657-65.

Ingrande J, Brodsky JB, Lemmens HJM. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg. 2011;113:57-62.

Lin TC, Lu CC, Hsu CH, Wu GJ, Lee MS, Ho ST. Duration effect of desflurane anesthesia and its awakening time and arterial concentration in gynecologic patients. Clinics 2013;68:1305-11.

Eger EI, Gong D, Koblin DD, Bowland T, Ionescu P, Laster MJ, et al. The effect of anesthetic duration on kinetic and recovery characteristics of desflurane versus sevoflurane, and on the kinetic characteristics of compound A, in volunteers. Anesth Analg 1998;86:414-21.

Gindre B, Baulieux D. Correlation of age-recovery time and the length of procedure-recovery time with propofol. Ann Fr Anesth Reanim 1989;8:78.

Pascoe PJ, Ilkiw JE, Frischmeyer KJ. The effect of the uration of propofol administration on recovery from anesthesia in cats. Vet Anaesth Analg 2006;33:2-7.

Mahli A, Coskun D, Karaca GI, Akcali DT, Karabiyik L, Karadenizli Y. Target-controlled infusion of remifentanil with propofol or desflurane under bispectral index guidance: Quality of anesthesia and recovery profile. J Res Med Sci 2011;16:611-20.

Rasmussen LS. Postoperative cognitive dysfunction: Incidence and prevention. Best Pract Res Clin Anaesthesiol 2006;20:315-30.

Röhm KD, Piper SN, Suttner S, Schuler S, Boldt J. Early recovery, cognitive function and costs of a desflurane inhalational vs. a total intravenous anaesthesia regimen in long-term surgery: Costs and cognitive function after desflurane vs. TIVA. Acta Anaesthesiol Scand 2006;50:14-8.

Harrison C, Remoundos DD, Harvey KL, Stoker GV, MacLean G, Adwani A, et al. Increasing the incidence of drain‐free day‐case mastectomies with the use of a fibrin tissue sealant; data from a single surgical center in the United Kingdom. Breast J 2019;25:1090-6.

Juvin P, Servin F, Giraud O, Desmonts JM. Emergence of elderly patients from prolonged desflurane, isoflurane, or propofol anesthesia. Anesth Analg 1997;85:647-51.

Rapp SE, Conahan TJ, Pavlin DJ, Levy WJ, Hautman B, Lecky J, et al. Comparison of desflurane with propofol in outpatients undergoing peripheral orthopedic surgery. Anesth Analg 1992;75:572-9.

Mahmoud NA, Rose DJ, Laurence AS. Desflurane or sevoflurane for gynaecological day-case anaesthesia with spontaneous respiration? Anaesthesia 2001;56:171-4.

Galasko D, Abramson I, Corey-Bloom J, Thal LJ. Repeated exposure to the mini-mental state examination and the information-memory-concentration test results in a practice effect in Alzheimer’s disease. Neurology 1993;43:1559-63.