Comparison of Haemodynamic Stability and Early Recovery Characteristics of Desflurane versus Sevoflurane in Robotic Prostatectomy: A Randomised Clinical Study

Abstract

Introduction: An ideal anaesthetic for robotic surgery would allow for a quick induction with minimal discomfort, as well as a short operation duration, quick recovery, and minimal aftereffects. Additionally, it would enable speedy recovery. Aim: To compare the haemodynamic stability and recovery characteristics of sevoflurane with desflurane for robotic surgery. Materials and Methods: The present randomised clinical study was conducted for four years from January 2019 to January 2023 and included 60 patients undergoing elective robotic radical prostatectomy and randomised into the group receiving desflurane (Group D) and that receiving sevoflurane (Group S). All patients were monitored using the Bispectral index (BIS) monitor, in addition to standard monitoring. General anaesthesia was administered using midazolam, fentanyl, propofol, atracurium, and either desflurane or sevoflurane based on the assigned group. Throughout the surgery, patients’ haemodynamic stability was monitored, and vital signs were recorded at induction, intubation, after assuming the Trendelenburg position, and at 30-minute intervals, until extubation. The inhalational agent was turned off at skin closure, and the time to spontaneous eye opening (T1), time to extubation (T2), and time to verbal response (T3) were noted. After the verbal response, patients were assessed based on the Modified Aldrete Score (MAS) with a threshold of ≥9. Pulse rate, blood pressure, BIS, and MAS were recorded during this time period. Data was presented as mean, frequency, and percentage. MAS comparison among the study groups was assessed using the Chi-square test. Demographic, haemodynamic, and BIS variables were compared using paired t-tests. Results: The mean age of patients in group S was 67.67±6.07 years, while in group D, it was 65.17±6.69 years. The time required for extubation after turning off the agent was significantly shorter in group-D compared to group-S, with a mean of 16.07±13.00 minutes in group-D and 21.71±9.07 minutes in group-S (p-value=0.0001). The percentage of patients achieving MAS >9 at five minutes was significantly higher in group D. Additionally, the use of both agents was not associated with any major complications. Conclusion: Desflurane as the inhalational agent ensures faster recovery in the early postoperative period and minimal changes in haemodynamic parameters compared to sevoflurane. However, sevoflurane has fewer complications compared to desflurane.