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 ( 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.