Balanced anesthesia with dexmedetomidine added desflurane or sevoflurane in spinal surgery

Abstract

Objectives: Sevoflurane and desflurane inhalational anesthetics are used for fast-track neuroanesthesia. Dexmedetomidine is used to provide analgesia, sedation and hemodynamic stability. Other anesthetic and analgesic requirements decrease when dexmedetomidine is administered, thus it is an interesting option for intraoperative agent for general anesthesia. We aim to compare desflurane and sevoflurane with dexmedetomidine in the operating room (OR) and Post-Anesthesia Care Unit (PACU) by using Fast-Tract -Criteria (FTC) and Aldrete Criteria (AC) for spinal surgery patients. Methods: A double-blind study was conducted. One hundred ASA I-II patients aged 18-65 were randomly divided into two groups. Following the standard anesthesia induction, Group (D+D) (n=50) received 2-4 % desflurane + 0.2 μg/kg/h dexmedetomidine and Group (S+D) (n=50) received 1-3 % sevoflurane + 0.2 μg/kg/h dexmedetomidine in 60 % N2O for anesthesia management. Extubation times, and FTC and AC were evaluated in the OR at the 5th and 10th minutes and in PACU at the 5th, 15th and 25th minutes. P< 0.05 was considered significant. Results: Demographic features of the patients in the two groups were similar. Extubation time in Group (D+D) was shorter than that in Group (S+D) (5.9 ± 2.4 and 8.3 ± 3.9 min respectively, p=0.001). In OR at the 10th min, and in PACU at the 5th min; Group (D+D) had a higher AC score than did Group (S+D) (p=0.001), and also at the 15th min., Group (D+D) had a higher FTC (P=0.01) and AC (p=0.007) scores than did Group (S+D). In all the patients, targeted discharge points were achieved at the 25th minute in PACU Conclusions: Balanced anesthesia with desflurane / dexmedetomidine combination is superior to sevoflurane / dexmedetomidine in extubation time and time to reach an AC ≥ 9 and FTC ≥ 13 in spinal surgery. © 2012 Keles GT, et al.