European Journal of Cardiovascular Medicine

General anaesthesia is a medically induced, reversible state of unconsciousness characterized by amnesia, analgesia, immobility, and loss of protective reflexes. The ideal anaesthetic agent should provide rapid induction, stable intraoperative hemodynamics, and facilitate a smooth and swift recovery with minimal postoperative complications. In contemporary anaesthetic practice, volatile agents such as desflurane and sevoflurane are widely used for maintenance due to their favourable pharmacokinetic properties, particularly their low blood-gas solubility coefficients that allow for rapid emergence from anaesthesia [1,2].

Desflurane, with a blood-gas partition coefficient of 0.42, is known for its rapid elimination and faster recovery profile. In contrast, sevoflurane, with a coefficient of 0.69, though slightly slower in emergence, is non-pungent and well tolerated, making it more suitable for inhalational induction, especially in paediatric and sensitive populations [3,4]. Despite the advantages of desflurane, its use is sometimes limited by its airway irritant properties, which can cause coughing and breath-holding during induction [2].

The return of protective airway reflexes such as swallowing and coughing is crucial in determining readiness for extubation and preventing aspiration. Rapid recovery of these reflexes is particularly beneficial in ambulatory settings and surgeries requiring fast turnover [5]. Several studies have shown that desflurane may offer faster recovery of consciousness and airway reflexes compared to sevoflurane; however, results remain inconsistent, with variations attributed to differences in study design, surgical populations, and assessment parameters [1,4–6].

This study was undertaken to directly compare desflurane and sevoflurane with respect to the time taken for return of airway reflexes after anaesthetic discontinuation in adult patients undergoing elective surgery, with secondary evaluation of recovery characteristics, hemodynamic responses, and cognitive outcomes.

Study Design and Setting:

This was a prospective, randomized, comparative study conducted in the Department of Anaesthesiology at Gandhi Medical College and Hospital, Secunderabad, Telangana, over a period of one year after obtaining approval from the Institutional Ethics Committee.

Study Population:

A total of 60 adult patients aged between 18 and 60 years, belonging to ASA physical status I or II and scheduled for elective surgical procedures under general anaesthesia, were enrolled. Informed written consent was obtained from all participants.

Inclusion Criteria:

Adult patients aged 18–60 years

ASA physical status I and II

Elective surgeries of duration 60–90 minutes

Willingness to participate and provide informed consent

Exclusion Criteria:

Anticipated difficult airway

Known hypersensitivity to study drugs

Significant cardiovascular, pulmonary, hepatic, renal or neurological disorders

Pregnancy or lactation

History of substance abuse

Randomization and Group Allocation:

Patients were randomized into two groups (n=30 each) using a computer-generated random number table:

Group D (Desflurane): Received desflurane for maintenance of anaesthesia

Group S (Sevoflurane): Received sevoflurane for maintenance

Anaesthetic Technique:

All patients were premedicated with midazolam (0.02 mg/kg IV) and glycopyrrolate (0.004 mg/kg IV). Standard monitoring included ECG, non-invasive blood pressure, pulse oximetry, capnography, and temperature. Anaesthesia was induced with intravenous fentanyl (2 μg/kg) and propofol (2 mg/kg). Neuromuscular blockade was achieved with vecuronium (0.1 mg/kg) to facilitate endotracheal intubation.

Anaesthesia was maintained with either desflurane (Group D) or sevoflurane (Group S) in a mixture of oxygen and nitrous oxide (50:50), titrated to maintain a MAC of 1.0. Additional doses of vecuronium were administered as required.

Emergence and Recovery Assessment:

At the end of surgery, volatile agents were discontinued, and neuromuscular blockade was reversed with neostigmine (0.05 mg/kg) and glycopyrrolate (0.01 mg/kg).

Patients were assessed for:

Time to eye opening on verbal command

Time to extubation

Time to obey verbal commands

Time to first successful swallowing effort

Hemodynamic Parameters:

Systolic and diastolic blood pressure, heart rate, and oxygen saturation were monitored perioperatively and postoperatively.

Cognitive Function and Side Effects:

Postoperative cognitive function was assessed using the Mini-Mental State Examination (MMSE) score. Adverse events such as nausea, vomiting, and airway-related events were recorded.

Statistical Analysis:

Data were analyzed using SPSS version 21. Continuous variables were presented as mean ± standard deviation and compared using the independent t-test. Categorical variables were expressed as frequencies and percentages and compared using the chi-square test. A p-value < 0.05 was considered statistically significant.

A total of 60 adult patients scheduled for elective surgery under general anaesthesia were enrolled and randomly assigned to two equal groups to receive either desflurane or sevoflurane for maintenance of anaesthesia. Both groups were comparable in baseline demographic parameters. There were no statistically significant differences between the groups in terms of age, gender distribution, weight, or ASA physical status (Table 1).

Table 1: Demographic Characteristics of Study Participants

Recovery Characteristics

Recovery parameters demonstrated significantly faster emergence in the desflurane group. The mean time to eye opening was significantly shorter in the desflurane group (5.37 ± 0.85 minutes) compared to the sevoflurane group (7.43 ± 1.08 minutes, p < 0.001). Similarly, the time to extubation (6.15 ± 0.91 vs. 8.05 ± 1.15 minutes), response to verbal commands (6.60 ± 0.83 vs. 8.53 ± 1.12 minutes), and return of airway reflexes (6.33 ± 0.88 vs. 8.23 ± 1.25 minutes) were significantly faster in the desflurane group (p < 0.001 for all comparisons) (Table 2).

Table 2: Recovery Parameters

Hemodynamic Parameters

Postoperative hemodynamic variables including mean systolic blood pressure, diastolic blood pressure, and heart rate remained stable in both groups. There were no significant intergroup differences in mean SBP (122.4 ± 9.5 vs. 124.1 ± 10.2 mmHg, p = 0.48), DBP (76.3 ± 8.1 vs. 77.1 ± 7.6 mmHg, p = 0.63), or heart rate (82.5 ± 7.8 vs. 80.8 ± 8.2 bpm, p = 0.42) (Table 3).

Table 3: Hemodynamic Parameters (Postoperative Period)

Adverse Effects and Analgesia

The incidence of postoperative nausea and vomiting was marginally higher in the desflurane group (13.3%) compared to the sevoflurane group (6.7%), though the difference was not statistically significant (p = 0.39). Postoperative analgesic requirement within the first two hours was comparable between the groups (20% vs. 26.7%, p = 0.54) (Table 4).

Table 4: Adverse Effects and Analgesic Requirement

Cognitive and Swallowing Function

Assessment of postoperative cognitive function using the Mini-Mental State Examination (MMSE) revealed slightly better scores in the desflurane group (28.7 ± 1.2) compared to the sevoflurane group (27.9 ± 1.5), which was statistically significant (p = 0.04). The time taken to perform the first swallowing action after following a verbal command was significantly shorter in the desflurane group (3.2 ± 0.6 minutes) than in the sevoflurane group (4.1 ± 0.9 minutes, p < 0.01) (Table 5).

Table 5: Cognitive and Swallowing Function

Rapid emergence from general anaesthesia is critical to ensuring patient safety, optimizing operating room efficiency, and facilitating early neurological assessment and airway management. In this study, desflurane demonstrated significantly faster recovery times across multiple clinical endpoints, including return of airway reflexes, eye opening, extubation, and response to verbal commands, compared to sevoflurane.

The mean time to return of airway reflexes was shorter in the desflurane group (6.33 ± 0.88 minutes) than in the sevoflurane group (8.23 ± 1.25 minutes; p < 0.001), consistent with findings reported by McKay et al., who observed faster recovery of airway protective reflexes with desflurane owing to its low blood-gas solubility coefficient [7]. This rapid emergence has important implications, particularly in settings where swift assessment and airway protection are essential.

Desflurane’s pharmacokinetic advantage is supported by meta-analytic data from Chen et al., who demonstrated that desflurane provided quicker recovery and superior cognitive outcomes in elderly patients when compared to sevoflurane [8]. In our study, patients receiving desflurane also exhibited significantly better early postoperative cognitive function as measured by MMSE scores (p = 0.04), aligning with the aforementioned meta-analysis.

Additionally, the faster restoration of swallowing reflex in the desflurane group (p < 0.01) indicates a quicker return of brainstem-mediated protective reflexes. Welborn et al. had similarly noted more rapid recovery profiles with desflurane in paediatric populations undergoing ambulatory procedures [9], suggesting that these benefits are consistent across age groups.

While both agents maintained stable hemodynamic parameters, the choice of desflurane was not associated with increased incidence of clinically significant airway complications in our study. This is in agreement with findings from Jadhav et al., who reported comparable safety profiles between desflurane and sevoflurane when used with a laryngeal mask airway [10].

Postoperative nausea and vomiting were slightly more frequent in the desflurane group, but the difference was not statistically significant. Gangakhedkar and Monteiro also found a higher, though non-significant, incidence of respiratory complications such as coughing with desflurane, which did not impact overall recovery quality [11].

Furthermore, Wu et al. reported better emergence characteristics and postoperative recovery quality in children undergoing tonsillectomy with desflurane, reinforcing the agent's potential for early discharge and functional recovery [12].

Taken together, our findings corroborate existing literature supporting desflurane’s efficacy in achieving faster and more consistent emergence from anaesthesia, including earlier return of protective reflexes and cognitive function. These advantages make desflurane particularly suitable for ambulatory and high-turnover surgical settings.

Limitations:

This study was limited by a relatively small sample size and single-center design. Additionally, long-term cognitive outcomes and patient satisfaction were not assessed. Future multicentric trials with larger sample sizes and broader outcome measures would help validate these findings.

This study demonstrated that desflurane facilitates significantly faster return of airway reflexes, earlier eye opening, extubation, and response to verbal commands compared to sevoflurane following discontinuation of anaesthesia. While both agents maintained stable hemodynamic parameters and had comparable adverse effect profiles, desflurane also showed a modest advantage in early postoperative cognitive recovery. These findings suggest that desflurane may be a more suitable volatile anaesthetic agent in situations demanding rapid emergence and airway safety, particularly in outpatient and short-duration surgeries. However, clinical decisions should consider patient-specific factors, and further studies are warranted to confirm long-term benefits and cost-effectiveness across diverse surgical populations.

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