Effects of changing from sevoflurane to desflurane on the recovery profile after sevoflurane induction: a randomized controlled study.

Purpose: Desflurane has the lowest solubility of currently available volatile anesthetics and may allow for more rapid emergence and recovery compared with sevoflurane. Nevertheless, after volatile induction with sevoflurane, it has not been determined whether the use of desflurane provides faster emergence and recovery. The present study aimed to elucidate the effects of changing from sevoflurane to desflurane during the early part of anesthesia.

Methods: Fifty-two patients who were scheduled for vitreous surgery with general anesthesia were enrolled in this randomized controlled study. Anesthesia was induced with volatile induction consisting of 100% oxygen (6 L·min(-1)) and 5% sevoflurane. For anesthesia maintenance, patients were randomized to receive 1-2% sevoflurane or 3-6% desflurane. In the desflurane group, the anesthetic agent was changed from sevoflurane to desflurane within five minutes following endotracheal intubation. After surgery, we assessed the following endpoints: the times from discontinuing volatile anesthetics to eye opening, obeying the command to squeeze the investigator's hand, tracheal extubation, and orientation to the patients' full name, date, and place.

Results: Emergence and recovery were significantly faster in the desflurane group than in the sevoflurane group in times to mean (SD) eye opening [6.5 (2.9) vs 10.1(3.0) min, respectively; mean difference, 3.6 min; 95% confidence interval (CI), 1.9 to 5.3; P < 0.001], obeying commands [6.6 (2.7) vs 10.1 (3.1) min, respectively; mean difference, 3.5 min; 95% CI, 1.9 to 5.2; P < 0.001], and tracheal extubation [7.0 (2.5) vs 10.6 (3.0) min, respectively; mean difference, 3.6 min; 95% CI, 1.9 to 5.1; P < 0.001]. Similarly, the times from discontinuation of volatile anesthetics to orientation to the patients' full name, date, and place were significantly shorter in the desflurane group compared with the sevoflurane group. There were no significant differences between groups on a 100-mm visual analogue scale assessing postoperative nausea and vomiting, eye pain, and patient satisfaction regarding anesthesia.

Conclusion: Changing the anesthetic agent from sevoflurane to desflurane after sevoflurane induction provides faster emergence and recovery compared with sevoflurane anesthesia. This study protocol was registered at http://www.umin.ac.jp/ctr/index.htm , (UMIN000009941).