Prema, R (2018) A comparative study of desflurane and sevoflurane in short surgical procedures like fibroadenoma under general anaesthasia with spontaneous respiration. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Short surgical procedures like Fibroadenoma excision are commonly performed as a daycare procedure which demands short, safe and effective balanced anaesthesia. Volatile anesthetics are commonly used for the maintenance of anesthesia nowadays. Diethyl ether was the first agent used in the history of volatile anaesthesia followed by Nitrous oxide to the most modern volatile anaesthetics like Desflurane and Sevoflurane1. These modern volatile anaesthetics form an important tool in patients undergoing general anaesthesia by altering central nervous system functions. In 1950, all halogenated older anaesthetics were withdrawn due to their hepatotoxicity except Nitrous oxide. The newer inhaled anaesthetics that are available today are introduced by replacing fluoride to hydrogen atom. Desflurane and Sevoflurane with low blood-gas partition coefficients have facilitated rapid induction of anaesthesia, precise control of end-tidal concentration during maintenance of anaesthesia and rapid recovery and less airway adverse effects at the end of anaesthesia. The rapid induction, recovery and clinical acceptance of Desflurane and Sevoflurane led to their use in daycare surgery. AIM OF THE STUDY: PRIMARY OBJECTIVE: TO compare the emergence, recovery, airway adverse effects of desflurane and sevoflurane in short surgical procedures like fibroadenoma using proseal LMA under general anaesthesia with spontaneous respiration. SECONDARY OBJECTIVE: To compare haemodynamic parameters such intraoperative Heart rate variability and MAP variability. METHODOLOGY AND MATERIALS: It’s a randomized comparative single blinded study conducted among 60 female patients divided into Group D and Group S of 30 each. Both groups are premedicated with Inj.glycopyrrolate 0.004mg/kg,Inj.emeset0.1 mg/kg, Inj.Fentanyl 1.5mcg/kg and preoxygenated for 3 minutes with 6litres of oxygen and induced with inj.propofol 2.5mg/kg and Proseal LMA inserted according to weight by myself and each maintaining with nitrous oxide : oxygen in ratio of 66 : 33 with endtidal desflurane 4% in Group D and endtidal sevoflurane1.2 % in Group S. After LMA removal emergence, recovery, airway adverse effects are all noted. RESULTS: The extent of exposure to anaesthetic was similar in both groups. Desflurane has rapid emergence (Time to response to painful stimulus, Time to response to verbal commands, spontaneous eye opening) and recovery (Time taken to LMA removal, Time taken to recall of names) incompared with sevoflurane and it is clinically significant (p<0.05). Desflurane had more incidence of airway adverse effects (cough, breath holding, laryngospasm) 9 out of 30 patients developed cough with SPO2 >95% and it is clinically significant (p value <0.01) . Conclusion: In our randomized comparative study between Desflurane and sevoflurane in fibroadenoma surgery we concluded that desflurane used for maintaince of a rapid emergence and recovery from anaesthesia with high incidence of cough with no significant heamodynamic changes compared with sevoflurane. PONV and other adverse effects were comparable between two groups.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Desflurane ; sevoflurane emergence ; airway adverse effects p ; proseal lma ; spontaneous respiration. |
| Subjects: | MEDICAL > Anaesthesiology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Aug 2018 04:37 |
| Last Modified: | 22 Aug 2018 04:37 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/9342 |
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