The Effect of Desflurane Versus Sevoflurane on Postoperative Recovery
Condition: Postoperative Recovery; Postoperative Delirium; Difference in Pharmakokinetics of Volatile Anesthetics
MeSH terms: Emergence Delirium
Study type: Interventional
Phase: Phase 4

Summary: 
      Patients over the age of 65 years are at increased risk for developing delirium and cognitive
      complications in the immediate postoperative period after noncardiac surgeries, resulting in
      increased morbidity and mortality. Previous small studies have shown beneficial effects of
      desflurane on postoperative cognitive recovery, which has been explained by the more rapid
      onset and offset of anesthesia as compared to sevoflurane. However, there are very limited
      data on the effect of desflurane on postoperative recovery and time until criteria for
      discharge from post-anesthesia care unit (PACU) are fulfilled in elderly patients undergoing
      minor-to moderate-risk noncardiac surgery. Therefore, the investigators will test the primary
      hypothesis that general anesthesia with desflurane significantly reduces the time between
      discontinuation of volatile anesthetics after the end of surgery and reaching ready for
      discharge from PACU criteria, which are defined as reaching a modified Aldrete score ≥ 12, as
      compared to sevoflurane in patients ≥ 65 years of age undergoing minor-to moderate-risk
      noncardiac surgery.
    

Detailed description: 
      Background: Patients over the age of 65 years are at increased risk for developing delirium
      and cognitive complications in the immediate postoperative period after noncardiac surgeries,
      resulting in increased morbidity and mortality. Previous small studies have shown beneficial
      effects of desflurane on postoperative cognitive recovery, which has been explained by the
      more rapid onset and offset of anesthesia as compared to sevoflurane. However, there are very
      limited data on the effect of desflurane on postoperative recovery and time until criteria
      for discharge from post-anesthesia care unit (PACU) are fulfilled in elderly patients
      undergoing minor-to moderate-risk noncardiac surgery. Therefore, the investigators will test
      the primary hypothesis that general anesthesia with desflurane significantly reduces the time
      between discontinuation of volatile anesthetics after the end of surgery and reaching ready
      for discharge from PACU criteria, which are defined as reaching amodified Aldrete score ≥ 12,
      as compared to sevoflurane in patients ≥ 65 years of age undergoing minor-to moderate-risk
      noncardiac surgery.

      Methods: The investigators will include 190 patients ≥ 65 years of age undergoing minor-to
      moderate-risk noncardiac surgery in this randomized, double-blinded clinical trial. Patients
      will be randomly assigned to receive desflurane or sevoflurane throughout surgery for
      maintenance of anesthesia. The primary outcome will be the time between discontinuation of
      desflurane until full postoperative recovery assessed via consecutive Aldrete Score
      assessments in the first 90 minutes after arrival at PACU. Aldrete Score will be assessed
      upon arrival at PACU and thereafter in five-minute intervals.

      Statistics: The primary outcome, the time from discontinuation of volatile anesthetic agent
      to reaching discharge criteria from PACU assessed via Aldrete Score values,will be compared
      between both study groups using a Mann-Whitney-U test. Furthermore, the investigators will
      perform a median regression model for time to Aldrete score ≥ 12 points accounting for group
      as a factor as well as further covariables e.g. age, gender, weight.

      Level of originality: Data regarding the effects of general anesthesia using desflurane in
      comparison to sevoflurane on postoperative recovery are mainly available from small studies.
      So far, there is very limited data on postoperative recovery and neurocognitive
      rehabilitation in elderly patients. However, this patient population is at a higher risk of
      developing postoperative neurocognitive complications, and could therefore, profit from a
      more rapid resurgence from anesthesia and postoperative recovery. Moreover, outpatient
      surgery will be becoming even more important. Therefore, reduction in postoperative PACU stay
      in combination with a decreased risk to develop postoperative delirium or cognitive
      dysfunction, might therefore improve outcome in this patient population as well.
    

Intervention name(s): Desflurane; Sevoflurane
Intervention type(s): Drug; Drug
Intervention description(s): After induction of anesthesia maintenance of anesthesia will be performed using goal-directed administration of desflurane with an intraoperative goal of bispectral index (BIS) 50±5.; After induction of anesthesia maintenance of anesthesia will be performed using goal-directed administration of sevoflurane with an intraoperative goal of bispectral index (BIS) 50±5.
Intervention MeSH terms: Sevoflurane; Desflurane
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: Minor- to moderate-risk noncardiac surgery; Desflurane; Sevoflurane; Postoperative recovery