Faculty Collaboration Database

Choice of volatile anesthetic for the morbidly obese patient: sevoflurane or desflurane. J Clin Anesth 2005 Sep;17(6):413-9

Date

09/21/2005

Pubmed ID

16171660

DOI

10.1016/j.jclinane.2004.12.015

Scopus ID

2-s2.0-24944557143 (requires institutional sign-in at Scopus site)   85 Citations

Abstract

STUDY OBJECTIVE: Morbid obesity is associated with significant comorbidities. Desflurane has a low fat-blood solubility coefficient and may be better suited in this population to achieve a rapid emergence; however, sevoflurane has favorable cardiorespiratory properties that might also prove advantageous in the morbidly obese (MO) patient. This study used careful drug titration to determine if emergence differences between sevoflurane and desflurane could be minimized in MO patients.

DESIGN: A randomized, prospective blinded study to determine the emergence profiles of desflurane and sevoflurane in MO patients when anesthetic drug titration is used.

SETTING: Operating room of the VA Medical Center, Milwaukee, Wis.

PATIENTS: Forty American Society of Anesthesiologists II and III, MO patients (body mass index > or = 35 kg/m2), who were scheduled for elective surgery predicted to last for more than 2 hours, were studied.

INTERVENTIONS: Patients were induced with fentanyl, midazolam, and propofol and maintained with desflurane or sevoflurane, mixed in air and oxygen. Intraoperative bispectral index (BIS) was targeted to 45 to 50 and to 60 in the last 15 minutes of surgery.

MEASUREMENTS: Intraoperative anesthetic concentration, BIS, and hemodynamics were recorded. During emergence, time to follow command and extubation were noted, with assessments of cognitive function via the Mini-Mental Status Test and psychomotor performance via the Digit Symbol Substitution Test. A blinded observer recorded key recovery events.

MAIN RESULTS: Demographic data (age, 61 [36-83] years; body mass index, 38 [35-47] kg/m2), surgical procedures, length of anesthesia (approximately 3.5 hours), adjuvant drugs, and intraoperative BIS, heart rate, and mean arterial pressure were not significantly different. Hemodynamics, time to follow commands and to extubation, and results of Digit Symbol Substitution Test and Mini-Mental Status Test did not differ between anesthetic groups during recovery.

CONCLUSIONS: There were no differences in emergence and recovery profiles in MO patients receiving desflurane or sevoflurane when anesthetic concentration was carefully titrated.

Author List

Arain SR, Barth CD, Shankar H, Ebert TJ

Authors

Thomas J. Ebert MD, PhD Adjunct Professor in the Anesthesiology department at Medical College of Wisconsin
Hariharan Shankar MD Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Anesthesia, Inhalation
Anesthetics, Inhalation
Atracurium
Body Mass Index
Chemical Phenomena
Chemistry, Physical
Cognition
Electroencephalography
Female
Hemodynamics
Humans
Isoflurane
Male
Methyl Ethers
Middle Aged
Neuromuscular Nondepolarizing Agents
Obesity, Morbid
Preanesthetic Medication
Prospective Studies
Psychomotor Performance