Comparison of the safety and efficacy of desflurane versus sevoflurane on postoperative cognitive function and early recovery quality in elderly orthopedic patients: a prospective, randomized controlled trial

Objective Desflurane is the most commonly suitable volatile anesthetic for elderly patients due to its low blood solubility, suggesting faster induction and awakening time. This study compared the safety and efficacy of desflurane versus sevoflurane in terms of postoperative cognitive function and early recovery quality in elderly orthopedic patients. Methods Eighty elderly patients undergoing orthopedic surgery were included in this prospective, randomized controlled trial. After preoxygenation with a 5 L/min fresh oxygen flow via a facial mask for 5 min, anesthesia was induced using 0.2 μg/kg sufentanil, 1–2 mg/kg etomidate, and 0.2 mg/kg cisatracurium. General anesthesia was maintained through continuous infusion of remifentanil (0.05–0.20 μg/kg/min) and a sevoflurane expiratory concentration of 1–2% or desflurane 2–5%, in combination with air containing 40% oxygen to maintain bispectral index (BIS) values 40–60. Data collected included hemodynamic parameters, time to eye-opening, extubation, following commands, orientation, post-anesthesia care unit (PACU) length of stay, opioid consumption, patient and surgeon satisfaction scores, number of patients willing to repeat surgery with the same anesthesia regimen, and adverse events. Additionally, white blood cell counts, percentages of neutrophils and lymphocytes, and troponin I levels were recorded at baseline and 24 h post-surgery. Results The Mini-Mental State Examination (MMSE) scores were lower at 1 h post-surgery in the desflurane group (D group) than in the sevoflurane group (S group), although the difference was not clinically significant ( p 0.05). Over 70% of patients in both groups returned to baseline MMSE levels 24 h postoperatively. There were no significant differences in MMSE scores at baseline, 6, 24, or 48 h post-surgery between the groups ( p 0.05). Patients in the D group recovered significantly faster, indicated by shorter times to eye-opening, extubation, following commands, and reduced PACU length of stay ( p 0.05). Patient and surgeon satisfaction scores and number of patients willing to repeat surgery with the same sedation regimen were significantly higher in the D group ( p 0.05), whereas white blood cell counts and percentage of neutrophils were significantly lower 24 h post-surgery in the D group ( p 0.05). No significant differences were observed in patient demographics, orientation times, opioid consumption, hemodynamics, adverse events, lymphocyte percentages, or troponin I levels between the groups ( p 0.05). Conclusion Desflurane was not associated with reduced MMSE scores or postoperative respiratory complications. However, it demonstrated faster recovery times and higher patient satisfaction scores than sevoflurane. Clinical trial registration ChiCTR2400093852.