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

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.