A post-operative comparison between Desflurane and Propofol used as part of a Remifentanil based anaesthetic

Dr C. Patel, Dr S. Nene and Dr S. Fenlon

Department of Anaesthetics, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK

Abstract

Remifentanil based anaesthesia, in conjunction with propofol (PROP) or desflurane (DES), are well recognised techniques that offer excellent haemodynamic stability and rapid recovery profiles.  In this study we compared the immediate and early emergence and recovery characteristics of these two techniques following prolonged anaesthesia.  Ethical approval was obtained, and 58 patients (16-75yrs, ASA 1-3, with expected surgical duration >3hr) were randomly assigned to receive PROP (n=26) or DES (n=32).  Standard induction of anaesthesia was commenced with a remifentanil infusion at 1mcg/kg/min followed by a bolus of propofol calculated at 3mg/kg.  The trachea was intubated and controlled ventilation commenced with O2/air.  Anaesthesia was maintained with remifentanil at 0.25mcg/kg/min, and either PROP 2.5mcg/ml via a target controlled infusion, or DES at 0.5 MAC.  Haemodynamic parameters were maintained within 20% of normal by stepwise changes in propofol of 0.1 mcg/ml, or desflurane of 1%.  All patients received cyclizine 50mg IV, morphine 0.2mg/kg IV and a non-steroidal anti-inflammatory.  At the end of surgery, all anaesthetic agents were stopped without tapering.  Times from the end of anaesthesia to return of spontaneous ventilation (SVT), eye opening (OET), tracheal extubation (EXT) and the ability to state name and date of birth were recorded (DOBT).  Additionally, pain and nausea scores, using a visual-analogue score, and usage of a patient controlled analgesia pump were recorded after 1, 2, 4, 6, 12 and 24hr.  Both anaesthesia methods resulted in stable intra-operative conditions.  Time to SVT, EXT and DOBT were all substantially and significantly quicker in the DES group; 30.6%, 31.4% and 39.6% respectively, with p values of <0.05, <0.05 and 0.013.  Both groups showed similar recovery profiles in the post-anaesthetic area and ward.  We demonstrated a transient benefit in emergence times using desflurane, but whether this is clinically important remains to be seen