Anesth Pain Med.  2020 Jan;15(1):35-40. 10.17085/apm.2020.15.1.35.

Does desflurane need more irrigating-pump pressure for the visibility in arthroscopic shoulder surgery than sevoflurane?

• Nam DJ
• Kim SH
• Park SH
• Lee H
• Kang BB
• Lee JH

• KMID: 2500452
• DOI: http://doi.org/10.17085/apm.2020.15.1.35

Abstract

Background
In arthroscopic shoulder surgery, a mechanical fluid-irrigation system is used to wash out blood from the joint. If used at high pressure, it can cause side effects such as fluid extravasation, leading to airway obstruction after surgery. Desflurane is prone to increasing sympathetic nerve activity and plasma catecholamine release more than another inhalation anesthetics. The objective of this study was to determine whether desflurane could increase in the irrigation pump pressure than sevoflurane in shoulder arthroscopy.
Methods
Patients were randomized into a sevoflurane group (group S) and a desflurane group (group D). Each included 20 patients. For group S, sevoflurane 1.2 MAC and intravenous remifentanil were administered for anesthesia maintenance. Group D received desflurane 1.2 MAC and intravenous remifentanil. Starting at 20 mmHg of pump pressure, the surgeon estimated the visibility of the surgical field (grade I–IV). After that, the pressure was freely adjusted by the surgeon to obtain clear vision with the arthroscope during the surgery.
Results
The maximum pressure of the mechanical water pump was higher in group D than group S (54.0 ± 6.8 mmHg vs. 48.9 ± 5.7 mmHg, P = 0.017), but the difference was not statistically significant at a significance level of 0.01. The arthroscopic visibility at the surgical site did not differ significantly between the two groups (P = 0.284).
Conclusions
When desflurane is used in arthroscopic shoulder surgery, it does not require more pressure from the irrigating-fluid pump to secure a clear vision of the surgical site, compared to sevoflurane.

Keyword

Arthroscopy; Desflurane; Pressure; Sevoflurane; Shoulder joint; Therapeutic irrigation

Figure

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  Fig. 1 Systolic blood pressure (SBP) at time schedule. Baseline, surgical start, 20, 40, and 60 min after surgical start. Values are presented as means ± SD. There were no differences between two groups in systolic pressure (P = 0.955).

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  Fig. 2 Diastolic blood pressure (DBP) at time schedule. Baseline, surgical start, 20, 40, and 60 min after surgical start. Values are presented as means ± SD. There were no differences between two groups in diastolic pressure (P = 0.709).

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  Fig. 3 Pulse rate at time schedule. Baseline, surgical start, 20, 40, 60 min after surgical start. Values are presented as means ± SD. There were no differences between two groups in pulse rate (P = 0.682). At the start of surgery, pulse rate of desflurane group was slightly higher than sevoflurane group. But, statistically, there were no differences between groups in pulse rate (P = 0.682).

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