Comparison of Recovery Profile of Propofol, Sevoflurane, and Desflurane Anesthesia in Transnasal Trans-sphenoidal Surgery for Pituitary Tumors: A Prospective Randomized Trial

Sonia Kapil; Nidhi Panda; Sujay Samanta; Asish Kumar Sahoo

doi:10.1055/s-0038-1669494

Journal of Neuroanaesthesiology and Critical Care, Table of Contents

CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2018; 05(03): 158-163
DOI: 10.1055/s-0038-1669494

Original Article

Indian Society of Neuroanaesthesiology and Critical Care

Comparison of Recovery Profile of Propofol, Sevoflurane, and Desflurane Anesthesia in Transnasal Trans-sphenoidal Surgery for Pituitary Tumors: A Prospective Randomized Trial

Authors

Sonia Kapil

¹Department of Anaesthesia, Fortis Hospital, Mohali, Punjab, India
Nidhi Panda

²Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Sujay Samanta

³Department of Critical Care, the Mission Hospital, Durgapur, India
Asish Kumar Sahoo

²Division of Neuroanaesthesia, Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Abstract

Background Smooth and early emergence is always a concern in neurosurgical patients as it prevents complication and facilitates neurological examination and immediate postoperative intervention, if necessary.

Methods A prospective randomized trial was conducted to evaluate the effects of propofol, sevoflurane, and desflurane used for maintenance of anesthesia at the time of emergence and recovery from anesthesia in 75 patients undergoing elective trans-sphenoidal surgery for pituitary tumors. We evaluated time for emergence and extubation, modified Short Orientation Memory Concentration Test (SOMCT) score, Aldrete's scores, pain score, and postoperative nausea and vomiting (PONV) score.

Results Emergence and extubation times were significantly shorter in patients receiving desflurane as compared with those receiving propofol or sevoflurane (p < 0.001). Modified SOMCT and Aldrete's scores were comparable in all the three groups with better cognitive scores in patients who received desflurane. Heart rate and mean arterial pressure were comparable at emergence and extubation in all the three groups except mean airway pressure (MAP) at extubation that was higher in the desflurane group compared with propofol and sevoflurane groups (p = 0.02), which was clinically comparable. Pain and PONV scores were also comparable between the groups.

Conclusions Desflurane had shorter time to emergence and time to extubation in comparison to propofol and sevoflurane. Thus, desflurane can be used as an alternative to propofol and sevoflurane for maintenance of anesthesia in patients undergoing transnasal trans-sphenoidal pituitary surgery for its excellent recovery profile after anesthesia.

Keywords

desflurane - emergence - propofol - sevoflurane - trans-sphenoidal pituitary surgery

Full Text

References

References
1 Horvat A, Kolak J, Gopcević A, Ilej M, Zivko G. Anesthetic management of patients undergoing pituitary surgery. Acta Clin Croat 2011; 50 (02) 209-216
2 Jindal R, Kumra VP, Narani KK, Sood J. Comparison of maintenance and emergence characteristics after desflurane or sevoflurane in outpatient anaesthesia. Indian J Anaesth 2011; 55 (01) 36-42
3 Eberts TJ, Schmid PG. Inhaled anesthetics. In: Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC. eds. Clinical Anesthesia. 6th ed.. Philadelphia: Lippincott Williams and Wilkins; 2009: 413-443
4 Morgan Jr GE, Mikhail MS, Murray MJ. Inhalational anesthetics. Clinical Anesthesiology. 4th ed.. New York: McGraw-Hill; 2006: 155-178
5 Nathanson MH, Fredman B, Smith I, White PF. Sevoflurane versus desflurane for outpatient anesthesia: a comparison of maintenance and recovery profiles. Anesth Analg 1995; 81 (06) 1186-1190
6 Ali Z, Prabhakar H, Bithal PK, Dash HH. Bispectral index-guided administration of anesthesia for transsphenoidal resection of pituitary tumors: a comparison of 3 anesthetic techniques. J Neurosurg Anesthesiol 2009; 21 (01) 10-15
7 Magni G, Rosa IL, Melillo G, Savio A, Rosa G. A comparison between sevoflurane and desflurane anesthesia in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth Analg 2009; 109 (02) 567-571
8 Bilotta F, Doronzio A, Cuzzone V, Caramia R, Rosa G. PINOCCHIO Study Group. Early postoperative cognitive recovery and gas exchange patterns after balanced anesthesia with sevoflurane or desflurane in overweight and obese patients undergoing craniotomy: a prospective randomized trial. J Neurosurg Anesthesiol 2009; 21 (03) 207-213
9 Bastola P, Bhagat H, Wig J. Comparative evaluation of propofol, sevoflurane and desflurane for neuroanaesthesia: A prospective randomised study in patients undergoing elective supratentorial craniotomy. Indian J Anaesth 2015; 59 (05) 287-294
10 Dube SK, Pandia MP, Chaturvedi A, Bithal P, Dash HH. Comparison of intraoperative brain condition, hemodynamics and postoperative recovery between desflurane and sevoflurane in patients undergoing supratentorial craniotomy. Saudi J Anaesth 2015; 9 (02) 167-173
11 Cafiero T, Cavallo LM, Frangiosa A. et al. Clinical comparison of remifentanil-sevoflurane vs. remifentanil-propofol for endoscopic endonasal transphenoidal surgery. Eur Anaesthesiol 2007; 24 (05) 441-446
12 Citerio G, Pesenti A, Latini R. et al; NeuroMorfeo Study Group. A multicentre, randomised, open-label, controlled trial evaluating equivalence of inhalational and intravenous anaesthesia during elective craniotomy. Eur J Anaesthesiol 2012; 29 (08) 371-379
13 Talke P, Caldwell JE, Brown R, Dodson B, Howley J, Richardson CA. A comparison of three anesthetic techniques in patients undergoing craniotomy for supratentorial intracranial surgery. Anesth Analg 2002; 95 (02) 430-435
14 Magni G, Baisi F, La Rosa I. et al. No difference in emergence time and early cognitive function between sevofluranefentanyl and propofol-remifentanil in patients undergoing craniotomy for supratentorial intracranial surgery. J Neurosurg Anesthesiol 2005; 17 (03) 134-138
15 Lauta E, Abbinante C, Del Gaudio A. et al. Emergence times are similar with sevoflurane and total intravenous anesthesia: results of a multicenter RCT of patients scheduled for elective supratentorial craniotomy. J Neurosurg Anesthesiol 2010; 22 (02) 110-118
16 Necib S, Tubach F, Peuch C. et al; PROMIFLUNIL trial group. Recovery from anesthesia after craniotomy for supratentorial tumors: comparison of propofol-remifentanil and sevoflurane-sufentanil (the PROMIFLUNIL trial). J Neurosurg Anesthesiol 2014; 26 (01) 37-44
17 Bruder N, Pellissier D, Grillot P, Gouin F. Cerebral hyperemia during recovery from general anesthesia in neurosurgical patients. Anesth Analg 2002; 94 (03) 650-654
18 Lim SH, Chin NM, Tai HY, Wong M, Lin TK. Prophylactic esmolol infusion for the control of cardiovascular responses to extubation after intracranial surgery. Ann Acad Med Singapore 2000; 29 (04) 447-451
19 Todd MM, Warner DS, Sokoll MD. et al. A prospective, comparative trial of three anesthetics for elective supratentorial craniotomy. Propofol/fentanyl, isoflurane/nitrous oxide, and fentanyl/nitrous oxide. Anesthesiology 1993; 78 (06) 1005-1020
20 Bilotta F, Caramia R, Paoloni FP. et al. Early postoperative cognitive recovery after remifentanil-propofol or sufentanil-propofol anaesthesia for supratentorial craniotomy: a randomized trial. Eur J Anaesthesiol 2007; 24 (02) 122-127
21 Sawaya R, Hammoud M, Schoppa D. et al. Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 1998; 42 (05) 1044-1055 discussion 1055–1056
22 Basali A, Mascha EJ, Kalfas I, Schubert A. Relation between perioperative hypertension and intracranial hemorrhage after craniotomy. Anesthesiology 2000; 93 (01) 48-54
23 Kaye AD, Kucera IJ, Heavner J. et al. The comparative effects of desflurane and isoflurane on lumbar cerebrospinal fluid pressure in patients undergoing craniotomy for supratentorial tumors. Anesth Analg 2004; 98 (04) 1127-1132
24 Weiskopf RB, Cahalan MK, Eger II EI. et al. Cardiovascular actions of desflurane in normocarbic volunteers. Anesth Analg 1991; 73 (02) 143-156
25 Daniel M, Eger II EI, Weiskopf RB, Noorani M. Propofol fails to attenuate the cardiovascular response to rapid increases in desflurane concentration. Anesthesiology 1996; 84 (01) 75-80