A comparative study of Desflurane versus Sevoflurane in elderly patients: Effect on early recovery

Position du problème et objectif(s) de l’étude

Postoperative delayed recovery and cognitive decline pose significant challenges in elderly patients. While inhalational agents like sevoflurane and desflurane—characterized by rapid emergence due to low blood/gas solubility—are widely used, comparative evidence on their recovery profile and cognitive impact remains sparse.This work aimed to compare the recovery profile for sevoflurane and desflurane in elderly patients undergoing non-cardiac surgery in order to identify the anesthetic technique that is optimal for them in terms of early recovery from anesthesia and postoperative cognitive function.

Matériel et méthodes

This was a prospective, comparative, randomized, controlled, single-blind study. The required sample size was estimated at 78 patients proposed for elective non-cardiac surgery, aged over 60 (WHO 2016b) and classified as ASA I, II and III stable,then randomized into two groups: S: Sevoflurane and D: Desflurane. Pre-anesthetic evaluation included SOMCT baseline scoring (Figure 1). Standardized protocols included induction (fentanyl/propofol/cisatracurium), and maintenance (tidal volume 6–7 mL/kg, ETCO₂ 30–40 mmHg). Volatile agents were discontinued at the end of surgery, with recovery metrics (eye-opening, extubation, response to verbal command) recorded. In post-anesthesia care unit (PACU) assessments included the modified Aldrete score (MAS) ≥9 (Figure 2) and SOMCT ≥20. Primary outcomes: time from anesthetic discontinuation to eye-opening, response to verbal command, extubation. Secondary outcomes: PACU discharge time, MAS/SOMCT recovery intervals.

Résultats & Discussion

Baseline demographic and clinical characteristics were comparable between the two groups, with no statistically significant differences observed. The median time to eye opening was 5 minutes in D group (IQR: 4–6) vs. 12.5 minutes in S group (IQR: 10–15) (p < 0.0001), median time to verbal response was 7 minutes vs. 16.1 minutes and 50% of group D patients achieved extubation within 8 minutes versus 18.75 minutes for S (p < 0.0001). Discharge time was shorter with desflurane (20 vs. 39 minutes; p < 0.0001) and time to reach MAS >= 9 was 17 minutes in group D compared to 30 minutes in group S. Cognitive recovery score (SOMCT) reaching >= 20 was at 20 minutes in group D vs. 43.5 in group S ; p < 0.0001). All outcomes reached statistical significance (p < 0.0001).

Conclusion

Desflurane significantly outperforms sevoflurane in elderly patients undergoing non-cardiac surgery, with faster early recovery. These results underscore desflurane’s pharmacokinetic advantages and support its use as the preferred inhalational anesthetic in this vulnerable population to minimize delayed emergence and cognitive decline.

Auteurs

Rihem KOUSRI (1) , Alia JEBRI (2), Yosra MOUELHI (1), Sbaii SAMEH (3), Boussessi RAJA (4) - (1)Résidente En Anésthésie Réanimatio, Tunis, Tunisie, (2)Profeseur Agrégé En Anésthésie Réanimation, Tunis, Tunisie, (3)Medecin Spécialiste En Anésthésie Réanimation, Tunis, Tunisie, (4)Assistante Hospitalo-Universitaire En Anésthésie Réanimation, Tunis, Tunisie

Orateur(s)

Rihem KOUSRI (Tunis)