Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials
Background and Aims: Despite its superior blood–gas partition coefficient compared to sevoflurane, use of desflurane in neurosurgery is limited due to concerns about cerebral vasodilation and potential adverse haemodynamic effects. This study aims to systematically evaluate the comparative efficacy...
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-01-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_1215_24 |
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| author | Hori Hariyanto Monika Widiastuti Carla Oktaviani Pandrya Kevin Anderson Surya William Audi |
| author_facet | Hori Hariyanto Monika Widiastuti Carla Oktaviani Pandrya Kevin Anderson Surya William Audi |
| author_sort | Hori Hariyanto |
| collection | DOAJ |
| description | Background and Aims:
Despite its superior blood–gas partition coefficient compared to sevoflurane, use of desflurane in neurosurgery is limited due to concerns about cerebral vasodilation and potential adverse haemodynamic effects. This study aims to systematically evaluate the comparative efficacy and safety of desflurane and sevoflurane in neurosurgical procedures.
Methods:
A search was performed in the Cochrane Library, Scopus, Europe PMC and Medline databases for articles published until 5 November 2024 using a combination of pertinent keywords. This review includes randomised controlled trials (RCTs) that analyse the comparison between desflurane and sevoflurane in neurosurgery. The risk of bias from each RCT was assessed using the Risk of Bias version 2 tool from Cochrane Collaboration. We utilised random-effects models to evaluate the mean difference (MD) and odds ratio (OR) for the outcomes presented.
Results:
Fourteen trials, encompassing 904 patients, were included in the analysis. Our analysis revealed significantly faster recovery profiles with desflurane, including reduced emergence time [MD -2.26; 95% confidence interval (CI): -2.99, -1.52, P < 0.00001, I2 = 71%], extubation time (MD -3.02; 95% CI: -3.89, -2.15, P < 0.00001, I2 = 79%) and overall recovery time (MD -3.26; 95% CI: -5.01, -1.51, P = 0.0003, I2 = 83%), compared to sevoflurane. Desflurane was associated with better postoperative cognitive function, as evidenced by higher short orientation memory concentration test scores – a measure of attention and memory – at 15 min (MD: 2.26; 95% CI: 0.13, 4.39, P = 0.04, I2 = 91%) and 60 min (MD: 0.29; 95% CI: 0.09, 0.50, P = 0.005, I2 = 0%) after extubation. We did not find any significant difference in the intra- and/or postoperative events, such as emergence agitation, nausea and vomiting, shivering, hypertension, hypotension, tachycardia, bradycardia, pain and convulsions, between the two groups of intervention.
Conclusion:
This study suggests that desflurane anaesthesia offers faster recovery with a similar safety profile to sevoflurane for neurosurgery. |
| format | Article |
| id | doaj-art-c2421b704d5a45248237d972077e69cd |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-c2421b704d5a45248237d972077e69cd2025-02-06T05:26:09ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-01-01691657710.4103/ija.ija_1215_24Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trialsHori HariyantoMonika WidiastutiCarla Oktaviani PandryaKevin Anderson SuryaWilliam AudiBackground and Aims: Despite its superior blood–gas partition coefficient compared to sevoflurane, use of desflurane in neurosurgery is limited due to concerns about cerebral vasodilation and potential adverse haemodynamic effects. This study aims to systematically evaluate the comparative efficacy and safety of desflurane and sevoflurane in neurosurgical procedures. Methods: A search was performed in the Cochrane Library, Scopus, Europe PMC and Medline databases for articles published until 5 November 2024 using a combination of pertinent keywords. This review includes randomised controlled trials (RCTs) that analyse the comparison between desflurane and sevoflurane in neurosurgery. The risk of bias from each RCT was assessed using the Risk of Bias version 2 tool from Cochrane Collaboration. We utilised random-effects models to evaluate the mean difference (MD) and odds ratio (OR) for the outcomes presented. Results: Fourteen trials, encompassing 904 patients, were included in the analysis. Our analysis revealed significantly faster recovery profiles with desflurane, including reduced emergence time [MD -2.26; 95% confidence interval (CI): -2.99, -1.52, P < 0.00001, I2 = 71%], extubation time (MD -3.02; 95% CI: -3.89, -2.15, P < 0.00001, I2 = 79%) and overall recovery time (MD -3.26; 95% CI: -5.01, -1.51, P = 0.0003, I2 = 83%), compared to sevoflurane. Desflurane was associated with better postoperative cognitive function, as evidenced by higher short orientation memory concentration test scores – a measure of attention and memory – at 15 min (MD: 2.26; 95% CI: 0.13, 4.39, P = 0.04, I2 = 91%) and 60 min (MD: 0.29; 95% CI: 0.09, 0.50, P = 0.005, I2 = 0%) after extubation. We did not find any significant difference in the intra- and/or postoperative events, such as emergence agitation, nausea and vomiting, shivering, hypertension, hypotension, tachycardia, bradycardia, pain and convulsions, between the two groups of intervention. Conclusion: This study suggests that desflurane anaesthesia offers faster recovery with a similar safety profile to sevoflurane for neurosurgery.https://journals.lww.com/10.4103/ija.ija_1215_24anaesthesiacognitive recoveryemergence timeextubationdesfluranemeta-analysisneuroanaesthesianeurosurgerysevofluraneshort orientation memory concentration testsystematic review |
| spellingShingle | Hori Hariyanto Monika Widiastuti Carla Oktaviani Pandrya Kevin Anderson Surya William Audi Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials Indian Journal of Anaesthesia anaesthesia cognitive recovery emergence time extubation desflurane meta-analysis neuroanaesthesia neurosurgery sevoflurane short orientation memory concentration test systematic review |
| title | Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials |
| title_full | Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials |
| title_fullStr | Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials |
| title_full_unstemmed | Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials |
| title_short | Comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries: A systematic review and meta-analysis of randomised trials |
| title_sort | comparison of desflurane and sevoflurane as maintenance inhalational anaesthetic agents for adult patients undergoing neurosurgeries a systematic review and meta analysis of randomised trials |
| topic | anaesthesia cognitive recovery emergence time extubation desflurane meta-analysis neuroanaesthesia neurosurgery sevoflurane short orientation memory concentration test systematic review |
| url | https://journals.lww.com/10.4103/ija.ija_1215_24 |
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