Inhalation Induction in Tracheostomized Patients: Comparison of Desflurane and Sevoflurane

Background: Inhalation induction (II) of anesthesia is a commonly used method in difficult airway management, pediatric anesthesia and also tracheostomized patients’ surgical practices. Sevoflurane and desflurane are the most common inhalation agents for II in these procedures of patients. We demonstrated that II with sevoflurane or desflurane in tracheostomized patients who are not studied up until now and their outcomes. Cardiorespiratory changes in II should be the same in tracheostomized patients with desflurane compared to sevoflurane. Methods: We studied 60 adult tracheostomized patients (ASA physical status 2 or 3), scheduled for elective surgery under general anesthesia. Patients were allocated randomly to receive either desflurane (Group D) or sevoflurane (Group S) for II. Following 1 mg midazolam and 1 μg/kg fentanyl, all patients were intubated via tracheostomy with a montandon tracheostomy tube. In the Group D, patients were firstly instructed to breath and then they immediately started using desflurane and 50% nitrous oxide in oxygen (3/3 L). Desflurane was introduced at an inspired concentration of 3% and increased by 1% every 4-6 breaths as tolerated, up to a maximum of 12%. In the Group S, patients were also instructed to breathe firstly and then they immediately started using sevoflurane and 50% nitrous oxide in oxygen (3/3 L). Sevoflurane was introduced at an inspired concentration of 1% and increased by 0.3% every 4-6 breaths as tolerated, up to a maximum of 6%. Hemodynamic values [(SpO2, heart rate (HR) and arterial pressure (MAP)], respiratory complications (coughing, bronchospasm, desaturation, breath-holding), purposeful movement of limbs, secretions requiring removal by suction, time to loss of response to command and concentration of expired inhalation agent (desflurane or sevoflurane) were recorded for 10 minutes of II. Mean, standard deviation, frequency and percentage were used for descriptive statistics with SSPS 20.0. Results: Couching, bronchospasm, desaturation, breathholding and purposeful movements distributions did not show any differences in Group D and Group S. Requirement of secretion removal was higher in Group D. Hemodynamic values were more stable in Group S. Conclusion: In tracheostomized patients’ II; desflurane has similar airway irritation with sevoflurane but II is more stable with sevoflurane than desflurane.