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Desflurane accelerates patient response during the wake-up test for scoliosis surgery

[Le desflurane hâte la réponse du patient pendant le test de réveil pendant le test de réveil d’une intervention chirurgicale pour scoliose]

From the Department of Anesthesiology, Veterans General Hospital-Taipei, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

Address correspondence to: Dr. Shen-Kou Tsai, Department of Anesthesiology, National Yang-Ming University and Taiwan University, Veterans General Hospital-Taipei, 201, Sec. 2, Shi-Pai Rd, Pei-Tou 112, Taipei, Taiwan. Fax: 886-2-28751597; E-mail: sktsai{at}vghtpe.gov.tw

Purpose: To evaluate if desflurane possesses a shorter wake-up onset time and less incidence of recall than fentanyl-based anesthesia.

Methods: Forty ASA class I–II adolescents, were enrolled into either a desflurane (DES) group, or a fentanyl (FEN) group for scoliosis surgery. Bispectral index (BIS) was monitored continuously in all patients throughout the procedure; the relationship between the wake-up time and BIS value was evaluated.

Results: Patients in the DES group had a significantly shorter wake-up onset than patients in the FEN group (4.1 ± 0.6 vs 8.9 ± 2.1 min, P < 0.01). No recall occurred during the wake-up test in the DES group, while five patients had recall in the FEN group, including two patients who recalled a given colour. Extubation time was significantly shorter in the DES group than in the FEN group (7.2 ± 0.6 vs 16 ± 11.9 min, P < 0.01).

BIS values were significantly higher in the FEN group than in the DES group during anesthesia. (62 ± 4.5 vs 42 ± 5.3, P < 0.05) BIS after the wake-up test was similar in both groups (90 ± 2.9 vs 93.8 ± 2.5). There was a latency period (3.3 ± 1.2 min) between the maximal BIS value and wake-up time in the FEN group but not in the DES group.

Conclusions: DES provides a significantly shorter onset time during the wake-up test and a rapid emergence after scoliosis surgery. BIS monitoring during the wake-up test was more informative when anesthesia was maintained with DES compared to FEN infusion.