• J Clin Anesth · Jun 2017

    Randomized Controlled Trial Comparative Study

    The effect of desflurane versus propofol anesthesia on postoperative delirium in elderly obese patients undergoing total knee replacement: A randomized, controlled, double-blinded clinical trial.

    Desflurane and propofol anesthesia are associated with similar incidence of post-operative delirium in the obese, elderly undergoing total knee replacement.

    • Pedro Tanaka, Stuart Goodman, Barbara R Sommer, William Maloney, James Huddleston, and Hendrikus J Lemmens.
    • Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305, USA. Electronic address: ptanaka@stanford.edu.
    • J Clin Anesth. 2017 Jun 1; 39: 17-22.

    Study ObjectiveThe goal of this study was to investigate the incidence of delirium, wake-up times and early post-operative cognitive decline in one hundred obese elderly patients undergoing total knee arthroplasty.DesignProspective randomized trial.SettingsOperating room, postoperative recovery area, hospital wards.Patients100 obese patients (ASA II and III) undergoing primary total knee replacement under general anesthesia with a femoral nerve block catheter.InterventionPatients were prospectively randomized to maintenance anesthesia with either propofol or desflurane.MeasurementsThe primary endpoint assessed by a blinded investigator was delirium as measured by the Confusion Assessment Method. Secondary endpoints were wake-up times and a battery of six different tests of cognitive function.Main ResultsFour of the 100 patients that gave informed consent withdrew from the study. Of the remaining 96 patients, 6 patients did not complete full CAM testing. Preoperative pain scores, durations of surgery and anesthesia, and amount of intraoperative fentanyl were not different between groups. One patient in the propofol group developed delirium compared to zero in desflurane. One patient in desflurane group developed a confused state not characterized as delirium. Fifty percent of the patients exhibited a 20% decrease in the results of at least one cognitive test on the first 2days after surgery, with no difference between groups. There were no differences in the time to emergence from anesthesia, incidence of postoperative nausea and vomiting, and length of postanesthesia care unit (PACU) stay between the two groups.ConclusionsIn conclusion we found a low incidence of delirium but significant cognitive decline in the first 48h after surgery. In this relatively small sample size of a hundred patients there was no difference in the incidence of postoperative delirium, early cognitive outcomes, or wake up times between the desflurane or propofol group.Copyright © 2017 Elsevier Inc. All rights reserved.

      Pubmed     Full text  

      Add institutional full text...



    Desflurane and propofol anesthesia are associated with similar incidence of post-operative delirium in the obese, elderly undergoing total knee replacement.

    Daniel Jolley  Daniel Jolley
    Do you have a pearl, summary or comment to save or share?
    250 characters remaining
    You can also include formatting and links in your notes
    • Simple formatting can be added to notes, such as _italic_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)


Want more great medical articles?

Keep up to date with a free trial of metajournal, personalized for your practice.
845,020 articles already indexed!

We guarantee your privacy. Your email address will not be shared.