Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 9  |  Issue : 1  |  Page : 45-51

Isoflurane versus desflurane: hemodynamic parameters and recovery characteristics: a comparative study


Department of Anaesthesia, ICU and Pain Management, Faculty of Medicine, Ain Shams University, Cairo, Egypt

Date of Submission27-Apr-2015
Date of Acceptance15-Aug-2015
Date of Web Publication17-Mar-2016

Correspondence Address:
Aktham A Shoukry
Block 129, Building No. 21, El Rehab City 11841
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-7934.178879

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  Abstract 

Introduction
Inhaled volatile anesthetics remain the most widely used drugs for maintenance of general anesthesia because of their ease of administration and predictable intraoperative and recovery characteristics. Management of hemodynamic stability and early recovery is the most important part of a standardized balanced technique. Given the low blood-gas partition coefficients of isoflurane (1.4) and desflurane (0.42), a more rapid emergence from anesthesia is expected compared with traditional inhalation anesthetics, The aim of this study was to compare the hemodynamic, emergence, and recovery characteristics of isoflurane with those of desflurane in general anesthesia for patients undergoing pelviabdominal operations.
Patients and methods
Ninety ASA I patients aged 15-50 years scheduled for elective abdominal or pelvic surgeries were enrolled in the study. Patients were allocated randomly into one of two groups (45 patients each): group I and group D. Group I patients received isoflurane (Forane) for maintenance of general anesthesia after a standardized induction sequence. Group D patients received desflurane (Suprane) for maintenance of general anesthesia after a standardized induction sequence.
Results
In the hemodynamic parameters, there were no statistically significant differences between the two groups in heart rate (after induction, after intubation, before skin incision, after skin incision, 5 min later, 10, 15, and 20 min later) (P > 0.05), but there was a significant increase in group D at 25, 30, 35, and 40 min later, just before extubation, and just after extubation (P < 0.05). On comparing the systolic blood pressure and the diastolic blood pressure, there were no significant differences between the two groups before induction, after induction, 5, 10, 15, 25, and 30 min later, just before extubation, and just after extubation (P > 0.05), but there was a significant increase in group D after intubation, after skin incision, and 20, 35, and 40 min later (P < 0.05).
In terms of postoperative complications and depth of anesthesia by the bispectral index, there were no significant differences between the study groups, but in terms of recovery characteristics, desflurane was more rapid.
Conclusion
The results of the study indicate that desflurane has better hemodynamic parameters and recovery characteristics in comparison with isoflurane in patients undergoing elective pelviabdominal operations.

Keywords: desflurane, hemodynamic, isoflurane, recovery


How to cite this article:
Shoukry AA, Laltif AA, Fattah AA, Ghani IA, Serag M. Isoflurane versus desflurane: hemodynamic parameters and recovery characteristics: a comparative study . Ain-Shams J Anaesthesiol 2016;9:45-51

How to cite this URL:
Shoukry AA, Laltif AA, Fattah AA, Ghani IA, Serag M. Isoflurane versus desflurane: hemodynamic parameters and recovery characteristics: a comparative study . Ain-Shams J Anaesthesiol [serial online] 2016 [cited 2019 Jun 24];9:45-51. Available from: http://www.asja.eg.net/text.asp?2016/9/1/45/178879


  Introduction Top


Inhaled volatile anesthetics remain the most widely used drugs for maintenance of general anesthesia because of their ease of administration and predictable intraoperative and recovery characteristics. Management of hemodynamic stability and early recovery is the most important part of a standardized balanced technique. Given the low blood-gas partition coefficients of isoflurane (1.4) and desflurane (0.42), a more rapid emergence from anesthesia is expected compared with traditional inhalation anesthetics [1] .

Isoflurane is an inhalational anesthetic whose low solubility (blood-gas partition coefficient equals 1.4) enables a rapid induction of and recovery from anesthesia. The mild pungency of isoflurane may limit the rate of induction, although excessive salivation or tracheobronchial secretions do not appear to be stimulated. The level of anesthesia may be altered rapidly with isoflurane. Pharyngeal and laryngeal reflexes are readily and easily obtunded [2] .

Desflurane (2, 2, 2-trifluoro-1-fluoroethyl-difluoromethyl ether) is a highly fluorinated methyl ethyl ether used for maintenance of general anesthesia. It is gradually replacing isoflurane for use in humans. It has the most rapid onset and offset of the volatile anesthetic drugs used for general anesthesia because of its low solubility in blood [3] .

The aim of this study was to compare the hemodynamic, emergence, and recovery characteristics of isoflurane with those of desflurane in general anesthesia for patients undergoing pelviabdominal operations.


  Patients and methods Top


This study was carried out in Ain Shams University Hospitals (isoflurane group) and Wady El-Nil Hospital (desflurane group) during the period from October 2011 to April 2014. The study protocol was approved by the 'Research and Ethics Committee' of the Anesthesia and Intensive Care Department, Ain Shams University. Informative consent was obtained from all patients or their legal guardians before enrollment in the study.

Ninety ASA I patients aged between 15 and 50 years scheduled for elective abdominal or pelvic surgeries were enrolled in the study. Patients were allocated into one of two groups (45 patients each), who received either isoflurane or desflurane for maintenance of general anesthesia after a standardized induction sequence.

Group I

Forty-five patients received isoflurane (Forane, Baxter Healthcare Corporation, Boston, USA) for maintenance of general anesthesia after a standardized induction sequence.

Group D

Forty-five patients received desflurane (Suprane) for maintenance of general anesthesia after a standardized induction sequence.

Exclusion criteria for the study were as follows: pregnancy or breast feeding, renal dysfunction as determined by creatinine levels more than 2 mg/dl, respiratory diseases such as chronic obstructive pulmonary disease and bronchial asthma, intraoperative complications such as (severe hypotension) when the mean arterial blood pressure (MAP) less than 55 mmHg (bradycardia) and when heart rate (HR) less than 50 beats/min, hepatic impairment such as an increase of liver enzymes serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase, known or suspected history of malignant hyperthermia, patients with coronary heart disease, and inability or unwillingness of patients or legal representative to provide written informed consent.

Methods

Anesthesia was induced with fentanyl 1 μg/kg, thiopental 4-7 mg/kg, and atracurium 0.5 mg/kg intravenously. After endotracheal intubation, ventilation was controlled to maintain ETCO 2 between 35 and 40 mmHg. Inhalational anesthesia was initiated in group I at 1% and in group D at 3%, followed by adjustment of volatile anesthetic concentration to maintain the MAP and HR within 20% of the preinduction baseline values or by clinical signs of light anesthesia (lacrimation, flushing, or sweating). After 5 min, a supplemental dose of fentanyl (0.5 μg/kg) was administered. Atropine 0.5 mg was administered intravenously when HR decreased below 45 beats/min. Anesthetics were decreased only in response to hypotension not responsive to replacement of intraoperative fluid loss or treatment of bradycardia. Atracurium maintained neuromuscular blockade, as determined by one twitch visible of the train-of-four.

Sample size was calculated using PS (version 3.0.43; Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA) using the following parameters: MAP used as the primary goal where the power of the study was 80%, SD was ± 2, the mean was 20, and the α error was 0.05.

Patients were assigned to two groups and each group included 45 patients.

  1. Measurements of hemodynamics [systolic blood pressure (SBP), diastolic blood pressure (DBP), and HR] were performed first as baseline before induction of anesthesia and then after induction, after intubation, before skin incision, after skin incision, and every 5 min thereafter).
  2. Measurements of the depth of anesthesia during surgery were performed by bispectral index (BSI) in the two groups every 5 min and just before and after extubation, and the time between discontinuation of inhaled anesthetics to return of spontaneous movement and extubation was recorded.
  3. At the last skin suture, the volatile agent was stopped and controlled ventilation with 100% oxygen was continued until the end-tidal volatile anesthetic concentration was less than 0.1%. Residual neuromuscular blockade was reversed with a combination of neostigmine 2 mg and atropine 0.5 mg, intravenously.
  4. Recovery characteristics were measured as time of eye opening, time at which the patient could state his/her name, could walk, and time of the patient's discharge.
Statistical methods

Statistical analysis was carried out using SPSS (version 12.0; SPSS Inc., Chicago, Illinois, USA) software.

Numerical data were presented as mean and SD, whereas categorical data were presented as number of cases (%).

Comparison between the two groups was performed using either an unpaired Student's t-test (for numerical data), χ2 -test, or Fisher's exact test (for categorical data) whenever appropriate.

A difference with P value less than 0.05 was considered statistically significant; otherwise, it was insignificant.


  Results Top


Demographic data

In terms of age, sex, and type of surgery, there were no statistically significant differences between both groups (P > 0.05) [Table 1] and [Figure 1].
Figure 1: Types of surgery

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Table 1 Demographic data

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Hemodynamic parameters

The baseline HR readings and subsequent readings (after induction, after intubation, before skin incision, after skin incision, 5 min later, and 10, 15, and 20 min later) showed no statistically significant differences between both groups (P > 0.05).

Group D showed increases in the HR value at 25, 30, 35, and 40 min later, just before extubation, and just after extubation; this increase was statistically significant in comparison with Group I and in comparison with the baseline value (P < 0.05). However, there were no statistically significant changes in HR in group I in comparison with the baseline value [Table 2].
Table 2 Changes in heart rate (beats/min)

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In terms of SBP and DBP, there were no significant differences between the two groups (before induction, after induction, 5, 10, 15, 25, and 30 min later, just before extubation, and just after extubation) (P > 0.05), but there were significant differences between the two groups (after intubation, before, after skin incision, 20, 35, and 40 min later) (P < 0.05; [Table 3] and [Table 4].
Table 3 Changes in systolic blood pressure (mmHg)

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Table 4 Changes in diastolic blood pressure (mmHg)

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In terms of the bispectral index

There were no significant differences between the two groups as shown in [Figure 2].
Figure 2: The bispectral index (BSI) values

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Recovery characteristics

Comparison of recovery characteristics between the two groups showed a significant difference between them that was more rapid with desflurane as shown in [Table 5] (P < 0.05).
Table 5 Recovery characteristics

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Postoperative complications

There was no significant difference in postoperative complications between the two groups (P > 0.05; [Table 6].
Table 6 Postoperative complications

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  Discussion Top


This study compares the hemodynamic parameters and recovery characteristics in patients undergoing pelvic and abdominal operations. The study was carried out on 90 patients divided into two groups. Group I received isoflurane, whereas group D received desflurane. The two groups were compared in terms of HR, SBP, DBP, BSI values, recovery characteristics, and postoperative complications.

HR values showed significant differences between the two study groups at 25, 30, 35, and 40 min after skin incision, just before extubation, and just after extubation. In group I, HR values decreased (68.04 ± 8.79) at 25, 30, 35, and 40 min after skin incision, but increased (75 ± 9.72) just before extubation and just after extubation according to baseline HR values (71.1 ± 7.7). In group D, HR values decreased (75.1 ± 1.1) at 25 min after skin incision, but increased (77.3 ± 3.1) at 30, 35, and 40 min after skin incision, just before extubation, and just after extubation according to the baseline HR values (76.6 ± 6.8).

In agreement with these findings, Loan et al. [4] compared the HR changes in patients scheduled for dental surgeries as there were changes in HR in both groups that were greater in the desflurane group and statistically significant in the isoflurane group and desflurane group after induction of anesthesia.

Another study was carried out by Azad et al. [5] in patients scheduled for prolonged surgeries of more than 3 h. This study showed that there were significant differences between the isoflurane and desflurane groups in HR response to tracheal intubation as both anesthetics increased the HR during induction of anesthesia, but a hyperdynamic response of increased HR above 20% of the baseline values was observed more frequently in the desflurane group.

In terms of the SBP values in this study, there were significant differences between the two study groups after intubation, before skin incision, and 20, 35, and 40 min after skin incision. SBP values in group I were higher than those in group D after intubation and before skin incision according to SBP baseline values. SBP values in both groups were lower than SBP baseline values.

In agreement with these findings, Bennet et al. [6] , observed that there were statistically significant differences between isoflurane and desflurane groups at any time after incision as SBP increased greater than 20% of baseline when treated with a 30% increase in inspired anesthetic concentration for 3 min or until SBP was within 10% of baseline; it was also observed that anesthetic depth could be titrated more rapidly with desflurane compared with isoflurane.

In contrast to the current study, Dupont et al. [7] showed that there were no significant differences between isoflurane and desflurane groups as SBP was maintained within 20% of baseline values during maintenance by the two inhalational anesthetics in patients scheduled for elective lobectomy or pneumonectomy. This is may be because ventilation was controlled with a 50% oxygen-nitrous oxide mixture and additional doses of fentanyl 0.05 μg/kg were administered to control acute hemodynamic changes as the duration of operation was more than 3 h.

Similarly, the values of DBP in this study showed that there were significant differences between the two groups after induction, after intubation, before skin incision, and 10, 20, 35, and 40 min after skin incision. Group D showed lower DBP values (67.1 ± 6.1) after induction, before skin incision, 10, 20, 35, and 40 min after skin incision than DBP baseline values (77.7 ± 6.6) and compared with the DBP values of group I (80.3 ± 5.8).

In agreement with these findings, Fraga et al. [8] observed that there were significant differences between isoflurane and desflurane groups in patients scheduled for craniotomy and removal of brain tumors with no evidence of a midline shift as DBP decreased significantly in all patients compared with the baseline values.

The BSI values showed no significant differences between the two groups (43 ± 2.2 in group I vs. 41.2 ± 3.2 in group D).

In agreement with these findings, Fletcher et al. [9] , showed that there were no significant differences in the BSI values between isoflurane and desflurane groups in patients scheduled for correction of idiopathic scoliosis in pediatric patients as no differential effect was found.

Another study carried out by Kreuer et al. [10] showed that there were no significant differences in BSI values between isoflurane and desflurane groups in patients scheduled for radical prostatectomies.

Recovery characteristics in the current study were evaluated as time (time to open eyes, time to state name, time to walk, and time to fit for discharge). These were significantly shorter in the desflurane group compared with those in the isoflurane group.

In agreement with these findings, Bennett et al. [11] , compared emergence and recovery characteristics in elderly patients who received desflurane anesthesia with those who received isoflurane anesthesia. Desflurane showed a benefit for elderly patients in terms of providing more rapid recovery from anesthesia, leading to shorter postanesthesia care unit stay.

This is in agreement with a study carried out by Jakobsson et al. [12] , who studied female patients scheduled for elective gynecological laparoscopic procedures and showed that patients who received desflurane were extubated earlier and were able to state their name and date earlier than patients who had received isoflurane.

Another study carried out by Mallik et al. [13] showed that there were significant differences between isoflurane and desflurane groups among healthy patients scheduled for routine surgeries as recovery of patients from anesthesia was more rapid in the desflurane group and they were more alert than those of the isoflurane group.

In terms of postoperative complications such as nausea, vomiting, drowsiness, respiratory distress, and sore throat, there were no significant differences between isoflurane and desflurane groups in the current study.

In agreement with these findings, Wallenborn et al. [14] showed that in patients scheduled for lumbar disc surgery, there were no significant differences between the three inhalational anesthetics that they used (desflurane, sevoflurane, and isoflurane) in either the frequency or the severity of postoperative complications such as nausea, vomiting, drowsiness, respiratory distress, and sore throat.

In contrast to the current study, Hough and Sweeney [15] found significant differences between isoflurane and desflurane groups in the postoperative complications. Among the patients scheduled for knee arthroscopy, there were higher incidences of postoperative nausea and vomiting and a higher risk of perioperative respiratory complications in the isoflurane group than the desflurane group, but this is likely to be transient in nature and was not associated with delayed discharge in the desflurane group. The difference may be because of the use of spontaneous manual ventilation by laryngeal mask airway and patients received either isoflurane or desflurane in a mixture of 33% oxygen in 67% nitrous oxide.

In conclusion, the results of the study indicate that desflurane has better hemodynamic parameters and recovery characteristics in comparison with isoflurane in patients undergoing elective pelviabdominal operations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Nathanson MH, Fredman B, Smith I, White PF. Isoflurane versus desflurane for outpatient anaesthesia: a comparison of maintenance and recovery profile. Anesth Analg 1995; 81:1186-1190.  Back to cited text no. 1
    
2.
Eger EI, Eisenkraft JB, Weiskopf RB. The pharmacology of inhaled anaesthetics. 2nd ed. Chicago, IL: Health Press; 2003. P233.  Back to cited text no. 2
    
3.
Tsai SK, Lee C, Kwan WF, Chen BJ. Recovery of cognitive functions after anaesthesia with desflurane or isoflurane and nitrous oxide. Br J Anaesth 1992; 69:255-258.  Back to cited text no. 3
    
4.
Loan PB, Mirakhur RK, Paxton LD, Gaston JH. Comparison of desflurane and isoflurane in anaesthesia for dental surgery. Br J Anaesth 1995; 75:289-292.  Back to cited text no. 4
    
5.
Azad SS, Bartkowski RR, Witkowski TA, Marr AT, Lessin JB, Seltzer JL. A comparison of desflurane and isoflurane in prolonged surgery. J Clin Anesth 1993; 5:122-128.  Back to cited text no. 5
    
6.
Bennett JA, Mahadeviah A, Stewart J, Lingaraju N, Keykhah MM. Desflurane controls the hemodynamic response to surgical stimulation more rapidly than isoflurane. J Clin Anesth 1995; 7:288-291.  Back to cited text no. 6
    
7.
Dupont J, Tavernier B, Ghosez Y, Durinck L, Thevenot A, Moktadir-Chalons N, et al. Recovery after anaesthesia for pulmonary surgery: desflurane, sevoflurane and soflurane. Br J Anaesth 1999; 82:355-359.  Back to cited text no. 7
    
8.
Fraga M, Rama-Maceiras P, Rodiño S, Aymerich H, Pose P, Belda J. The effects of isoflurane and desflurane on intracranial pressure, cerebral perfusion pressure, and cerebral arteriovenous oxygen content difference in normocapnic patients with supratentorial brain tumors. Anesthesiology 2003; 98:1085-1090.  Back to cited text no. 8
    
9.
Fletcher JE, Hinn AR, Heard CM, Georges LS, Freid EB, Keifer A, et al. The effects of isoflurane and desflurane titrated to a bispectral index of 60 on the cortical somatosensory evoked potential during pediatric scoliosis surgery. Anesth Analg 2005; 100:1797-1803.  Back to cited text no. 9
    
10.
Kreuer S, Bruhn J, Wilhelm W, Grundmann U, Rensing H, Ziegeler S. Comparative pharmacodynamic modeling of desflurane, sevoflurane and isoflurane. J Clin Monit Comput 2009; 23:299-305.  Back to cited text no. 10
    
11.
Bennett JA, Lingaraju N, Horrow JC, McElrath T, Keykhah MM. Elderly patients recover more rapidly from desflurane than from isoflurane anesthesia. J Clin Anesth 1992; 4:378-381.  Back to cited text no. 11
    
12.
Jakobsson J, Rane K, Ryberg G. Anaesthesia during laparoscopic gynecological surgery: a comparison between desflurane and isoflurane. Eur J Anaesthesiol 2003; 14:148-152.  Back to cited text no. 12
    
13.
Mallik T, Aneja S, Tope R, Muralidhar V. A randomized prospective study of desflurane versus isoflurane in minimal flow anesthesia using 'equilibration time' as the change-over point to minimal flow. J Anaesthesiol Clin Pharmacol 2012; 28:470-475.  Back to cited text no. 13
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14.
Wallenborn J, Rudolph C, Gelbrich G, Goerlich TM, Derkolthoff JH. The impact of isoflurane, desflurane or sevoflurane on the frequency and severity of postoperative nausea and vomiting after lumber disc surgery. J Clin Anaesth 2007; 19:180-185.  Back to cited text no. 14
    
15.
Hough MB, Sweeney B. Postoperative nausea and vomiting in arthroscopic day-case surgery: a comparison between desflurane and isoflurane. Anaesthesia 1998; 53:910-914.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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