• Alexander Taschner, Edith Fleischmann, Katharina Horvath, Nikolas Adamowitsch, David Emler, Thomas Christian, Nicole Hantakova, Beatrix Hochreiter, Laura Höfer, Magdalena List, Barbara Rossi, Florian W Zenz, Giulia Zanvettor, Oliver Zotti, Alexandra Graf, Melanie Fraunschiel, and Christian Reiterer.
• Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, 1090 Vienna, Austria.
• J Clin Anesth. 2024 Nov 1; 98: 111576111576.

Study ObjectiveThe effect of volatile anesthetics on postoperative recovery in older adults is still not entirely clear. Thus, we evaluated the effect of desflurane versus sevoflurane anesthesia on speed of postoperative recovery in older adults eligible for same-day discharge. We further evaluated the incidence of postoperative nausea and vomiting (PONV), bispectral index (BIS) values, and S100B concentrations.DesignSingle-center, prospective, observer-blinded, randomized clinical trial.SettingOperating room.Patients190 patients ≥65 years of age and scheduled for minor- to moderate-risk noncardiac surgeries.InterventionsGoal-directed administration of desflurane versus sevoflurane for maintenance of anesthesia with an intraoperative goal of BIS 50 ± 5.MeasurementsThe primary outcome was the time to anesthesia recovery, which was defined as the time between arrival at the post-anesthesia care unit (PACU) and reaching criteria for discharge from PACU, based on modified Aldrete score ≥ 12 points. Modified Aldrete scores were assessed at PACU arrival and thereafter in five-minute intervals. PONV was evaluated during PACU stay and the first three postoperative days, BIS values were recorded during PACU stay, and S100B values were measured before and after surgery, and on the second postoperative day.Main Results95 patients were randomized to receive desflurane, and 95 patients to receive sevoflurane. We did not observe a significant difference in median duration of postoperative recovery between the groups (desflurane: 0 min [0;0]; sevoflurane: 0 min [0;0]; p = 0.245). 77 patients (81.1%) in the desflurane group and 84 patients (88.4%) in the sevoflurane group already had Aldrete scores ≥12 points upon arrival at PACU (p = 0.277). There was also no significant difference in the incidences of PONV (p = 0.606), postoperative BIS values (p = 0.197), and postoperative maximum S100B concentrations (p = 0.821) between the groups.ConclusionsDespite previous reports, we did not observe significant faster recovery times after desflurane anesthesia. Both volatile anesthetics may be appropriate for same-day discharge in older adults.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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