ELDERLY PATIENTS RECOVER MORE RAPIDLY FROM DESFLURANE THAN FROM ISOFLURANE ANESTHESIA

Study Objective: To compare the hemodynamic, emergence, and recovery characteristics of desflurane-nitrous oxide (N2O) anesthesia with those of isoflurane-N2O anesthesia in elderly patients. Design: Randomized study. Setting: Main operating room of a major U.S. teaching hospital. Patients: Thirty-four ASA physical status II and III patients aged 65 or older undergoing surgical procedures of greater than 1 hour duration. Interventions: Group 1 (17 patients) received desflurane in 60% N2O) for their surgical procedure. Group 2 (17 patients) received isoflurane in 60% N2O. Thiamylal 2 mg/kg administered intravenously (IV) induced anesthesia, and succinylcholine 1.5 mg/kg IV facilitated intubation. Muscle relaxation was maintained with vecuronium. Titration of the anesthetics maintained hemodynamics to within 20% of the patients' preinduction values. Measurements and Main Results: Measurement of hemodynamics occurred every 2 minutes prior to skin incision and every 5 minutes thereafter. The times for discontinuation of inhaled anesthetics to eye opening, hand grip on command, and recall of name and date of birth were measured in a standardized fashion for both groups. The time to discharge from the postanesthesia care unit (PACU) was determined by a blinded PACU nurse using standard published criteria. The two groups did not differ with respect to demographics, hemodynamic stability, and times to eye opening (5 +/- 3 minutes for desflurane vs. 8 +/- 4 minutes for isoflurane), hand grip on command (9 +/- 4 minutes vs. 12 +/- 1 minutes), and recall of name and date of birth (13 +/- 8 minutes vs. 12 +/- 7 minutes). The median duration of PACU stay was significantly shorter (p < 0.03) in the desflurane group (80 minutes) compared to the isoflurane group (128 minutes). Conclusions: Desflurane may benefit elderly patients by providing a more rapid recovery from anesthesia, leading to a shorter PACU stay.