Comparison of postoperative delirium in patients anesthetized with isoflurane versus desflurane during spinal surgery: A prospective randomized controlled trial
- Departments of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Departments of Orthopedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Departments of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Departments of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
DOI:10.25259/SNI_287_2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Steve Joys, Tanvir Samra, Vishal Kumar, Manju Mohanty, Harsimrat B. S. Sodhi, Shalvi Mahajan, Hemant Bhagat. Comparison of postoperative delirium in patients anesthetized with isoflurane versus desflurane during spinal surgery: A prospective randomized controlled trial. 22-Nov-2019;10:226
How to cite this URL: Steve Joys, Tanvir Samra, Vishal Kumar, Manju Mohanty, Harsimrat B. S. Sodhi, Shalvi Mahajan, Hemant Bhagat. Comparison of postoperative delirium in patients anesthetized with isoflurane versus desflurane during spinal surgery: A prospective randomized controlled trial. 22-Nov-2019;10:226. Available from: http://surgicalneurologyint.com/surgicalint-articles/9770/
Background: Following spine surgery, different types of inhalational anesthetic agents can result in postoperative delirium (POD) that can increase perioperative/postoperative morbidity. Here, we compared the incidence of POD in adults undergoing spine surgery anesthetized with isoflurane versus desflurane.
Methods: A prospective randomized double-blind clinical trial for patients undergoing spinal surgery was performed in 60 adults (aged 18–65 years); they were randomized to receive isoflurane or desflurane. On postoperative days 1 and 3, the diagnosis and severity of POD utilized 3D-Confusion Assessment Method (CAM) and CAM-severity delirium severity scores to assess patients’ status. Multiple other variables which may have influenced the frequency/severity of POD were also studied.
Results: For the two groups, the incidence of POD utilizing isoflurane and desflurane was similar on postoperative days 1 (10% vs. 13.3%, P > 0.05) and 3 (6.6% vs. 0%, P > 0.05). The severity scores of POD for both anesthetic agents were also similar on postoperative days 1 (1.5 vs. 1) and 3 (0.5 vs. 0.5). In addition, there was no significant association of POD with other perioperative factors.
Conclusion: A significant number of patients undergoing spine surgery experience POD. However, the incidence and severity of POD remained similar when utilizing either isoflurane or desflurane.
Keywords: Desflurane, Isoflurane, Postoperative delirium, Spine surgery
Postoperative delirium (POD) occurs between 24 and 72 h after any surgery and can persist for months.[
Desflurane and isoflurane are two commonly used inhalational anesthetic agents. While animal studies have shown prolonged exposure to isoflurane may be neurotoxic, clinical series have reported faster emergence and less postoperative cognitive dysfunction (POCD) utilizing desflurane.[
A prospective randomized double-blind clinical trial was conducted (2016–2017) in 60 patients, ages 18–65 years old, scheduled to undergo spine surgery; they provided written informed consent [
Patients were screened for cognitive dysfunction preoperatively using the Mini-Cog Test.[
Postoperative assessment of POD
The results of a previously conducted study on POCD comparing isoflurane and desflurane were used to calculate the sample size in our study to prove the superiority of desflurane over isoflurane with a margin of at least 5% using an alpha error of 0.05 and power of 85%.[
There were no statistically significant differences utilizing isoflurane versus desflurane on the incidence of POD between the two groups on postoperative days 1 (10% vs. 13.3%) and 3 (6.6% vs. 0%), respectively [
Comparable outcomes for POD with isoflurane versus desflurane
Our original hypothesis was that isoflurane may be associated with an increased incidence of POD versus desflurane in patients undergoing spinal surgery. We found the incidence and severity of POD in middle-aged adults undergoing spine surgery were similar on postoperative days 1 and 3.
Animal studies have demonstrated different incidences of neurotoxicity utilizing isoflurane and desflurane as inhalational anesthetics; some studies showed isoflurane to be neurotoxic, while others demonstrated both isoflurane and desflurane were neuroprotective.[
Prior incidence of POD in patients undergoing spine surgery
Previous studies on POD following spine surgery showed a higher incidence of delirium in patients older than 60 years.[
The study included only 60 patients randomized to two different anesthetic groups, and the study was only continued for 3 postoperative days. Further, the baseline incidence of preoperative cognitive dysfunction was higher in the isoflurane (n = 7) versus desflurane groups (n = 1).
The incidence and severity of POD in middle-aged patients receiving either isoflurane or desflurane for spine surgery were similar on postoperative days 1 and 3.
Clearance to conduct the study was obtained from the Institute Ethics Committee on April 4, 2016 (reference number 10313/PG-2Trg/2015/5408-9), in accordance with the Helsinki Declaration of 1975, as revised in 2000. The trial was registered with clinicaltrials.gov on October 6, 2016 (clinicaltrials.gov identifier NCT02925611).
The authors certify that they have obtained all appropriate patient consent forms.
There are no conflicts of interest.
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