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Recovery of older patients undergoing ambulatory anaesthesia with isoflurane or sevoflurane

Published online by Cambridge University Press:  01 June 2007

V. A. Mahajan ,
M. Ni Chonghaile ,
S. A. Bokhari ,
B. H. Harte ,
N. M. Flynn  and
J. G. Laffey
V. A. Mahajan
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland
M. Ni Chonghaile
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland Galway University Hospitals, Department of Anaesthesia, Galway, Ireland
S. A. Bokhari
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland
B. H. Harte
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland
N. M. Flynn
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland Galway University Hospitals, Department of Anaesthesia, Galway, Ireland
J. G. Laffey*
Affiliation:
National University of Ireland, Clinical Sciences Institute, and National Centre for Biomedical Engineering Sciences (NCBES), Department of Anaesthesia, Galway, Ireland Galway University Hospitals, Department of Anaesthesia, Galway, Ireland
*
Correspondence to: John Gerard Laffey, Department of Anaesthesia, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. E-mail: [email protected]; Tel: +353 91 544074; Fax: +353 91 544908
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Summary

Background

Delayed recovery of cognitive function is a well-recognized phenomenon in older patients. The potential for the volatile anaesthetic used to contribute to alterations in postoperative cognitive function in older patients following minor surgical procedures has not been determined. We compared emergence from isoflurane and sevoflurane anaesthesia in older surgical patients undergoing urological procedures of short duration.

Methods

Seventy-one patients, 60 yr of age or older, undergoing anaesthesia expected to last less than 60 min for ambulatory surgery, were randomly assigned to receive isoflurane or sevoflurane. A standardized anaesthetic protocol was used, with intravenous fentanyl 1 μg kg−1 and propofol 1.5–2.0 mg kg−1 administered to induce anaesthesia. Anaesthesia was maintained with either sevoflurane or isoflurane in 65% nitrous oxide and oxygen. Early and intermediate recovery times were recorded. The mini mental state examination and digit repetition forwards and backwards were administered at baseline, and at 1, 3 and 6 h postoperatively, to assess cognitive function.

Results

There were no between-group differences in (sevoflurane vs. isoflurane, mean ± standard error of the mean) times to removal of the laryngeal mask airway (7.7 ± 0.6 vs. 7.1 ± 0.4 min), verbal response time (10.1 ± 0.7 vs. 9.9 ± 0.7 min) and orientation (12.1 ± 0.7 vs. 12.1 ± 0.7 min). Intermediate recovery, as measured by time to readiness for discharge from the post anaesthesia care unit (44.9 ± 1.5 vs. 44.3 ± 1.5 min), was similar in the two groups. Postoperative indices of cognitive function and attention were comparably reduced at 1 h, but returned to baseline in both groups at 6 h.

Conclusions

Isoflurane and sevoflurane anaesthesia resulted in similar clinical and neurocognitive recovery profiles in older patients undergoing ambulatory surgical procedures of short duration.

Keywords

AMBULATORY CAREANAESTHESIA GENERALGERIATRICSANAESTHETICS INHALATIONAL, sevoflurane, isofluraneANAESTHESIA RECOVERY PERIOD, cognitive function
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 6 , June 2007 , pp. 505 - 510
Copyright
Copyright © European Society of Anaesthesiology 2006

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