This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gauthier, A. Articles by Girard, D. C. Search for Related Content PubMed Articles by Gauthier, A. Articles by Girard, D. C.

SEVO PROVIDES FASTER POSTOP NEURO EXAM THAN ISO AFTER NEUROSURGERY

Department of Anesthesiology, CHUM – Hopital Notre-Dame, 1560 Sherbrooke Est, Montréal, Québec, H2L 4M1

INTRODUCTION

It has been demonstrated that the use of inhalational anesthetics having a lower blood:gas partition coefficient results in faster emergence times and it is speculated that this advantage increases with the duration of anesthetic exposure. We designed a prospective randomized double-blind controlled clinical study to compare the recovery profile of Sevoflurane versus Isoflurane in neuroanesthesia of long duration.

METHODS

Following IRB approval and informed consent, 56 adult patients presenting for intracranial surgery were enrolled. They were randomized to receive either Sevoflurane (SEVO) or Isoflurane (ISO) in 40% oxygen (2 l/min.) as part of a balanced anesthesia regimen. Mean blood pressure and heart rate values were maintained at ± 20 % of the pre-induction baseline with adjustment of the anesthetic depth (0.5 to 1.0 MAC). Pharyngeal temperature was maintained above 35°C. Sufentanil infusion (0.25 µg/kg/h) was stopped at dural closure. At removal of the head holder, paralysis was reversed, anesthetics were discontinued and fresh gas flow increased to 10 l/min. Several recovery endpoints were measured as time from closure of the anesthetic vaporizer.

RESULTS

There were no difference in mean duration of anesthetic exposure [6.4 h SEVO vs. 6.8 h ISO, p=0.29] and amount of anesthetic needed during intervention were similar [MAC-h total 4.74 SEVO vs. 4.70 ISO, p=0.47]. Patients in SEVO demonstrated a shorter time to emergence (eye opening) [15 min. vs. 21 min. in the ISO group, p=0.02] and shorter time for response to command (movement of all limbs) [21 min. vs. 31 min. in the ISO group, p=0.01]. Differences in time to spontaneous breathing, time to extubation, time for orientation, time to first analgesic and time to discharge from PACU did not achieve statistical significance. Demographic data were similar in both groups.

DISCUSSION

As it is primordial in the neurosurgical population to quickly obtain a postoperative neurological evaluation, the observed difference between Sevoflurane and Isoflurane could afford a clinical advantage in this setting.

REFERENCES

Anesthesiology 89:1524–31

This Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gauthier, A. Articles by Girard, D. C. Search for Related Content PubMed Articles by Gauthier, A. Articles by Girard, D. C.