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 (N 2O) anesthesia with those of isoflurane-N 2O 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% N20) for their surgical procedure. Group 2 (17 patients) received isoflurane in 60% N20. Thiamylal 2 mglkg 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 (PAC U) 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 PAC U stay.