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. 2018 Aug 21;2018(8):CD012317. doi: 10.1002/14651858.CD012317.pub2

Juvin 1997.

Methods RCT, parallel design, single‐centre
Participants Total number of randomized participants: 45
Inclusion criteria

  1. ASA I or II, > 70 years of age, scheduled for major orthopedic surgery expected to last > 60 minutes. No participants had any clinical condition that might influence the assessment of variables used for the study and/or comparisons among groups


Excluded criteria

  1. Clinical conditions to contraindicate rapid extubation

  2. Preoperative haematocrit 25%

  3. Significant coronary disease

  4. ß‐blocker treatment

  5. Chronic pulmonary disease

  6. Previous neurologic insult

  7. Chronic alcohol or drug abuse

  8. Renal failure or hepatic dysfunction

  9. Previous personal or family history of malignant hyperthermia


Type of surgery: hip arthroplasty, knee arthroplasty, laminectomy, other orthopaedic surgery
Baseline characteristics
TIVA group

  1. Age, mean (SD): 75.6 (± 4.2) years

  2. Gender, M/F: 3/11

  3. ASA grade: ASA I: 1: ASA II: 13


Inhalational maintenance group (isoflurane)

  1. Age, mean (SD): 77.3 (± 5) years

  2. Gender, M/F: 3/12

  3. ASA grade: ASA 1: 2; ASA II: 13


Inhalational maintenance group (desflurane)

  1. Age, mean (SD): 77.4 (± 5.1) years

  2. Gender, M/F: 4/10

  3. ASA grade: ASA I: 1; ASA II: 13


Country: France
Setting: hospital
Interventions TIVA group
Participants: n = 15; 1 loss (excluded owing to intraoperative complication); 14 analysed
Induction details: propofol 1 mg/kg to 2 mg/kg, fentanyl 1 µg/kg to 2 µg/kg, vecuronium 0.1 mg/kg
Maintenance details: 60% N2O in O2. Propofol titrated to maintain HR and BP within 20% of baseline. Study authors report mean (SD) infusion rates at 2.18 (± 1.24) mg/kg/hour
Other information: premedication with oral hydroxyzine 100 mg. Additional fentanyl at 1 µg/kg at 40‐minute intervals depending on length of surgery
Inhalational maintenance group (isoflurane)
Participants: n = 15; 0 losses
Induction details: propofol 1 mg/kg to 2 mg/kg, fentanyl 1 µg/kg to 2 µg/kg, vecuronium 0.1 mg/kg
Maintenance details: 60% N2O in O2. Isoflurane titrated to maintain HR and BP within 20% of baseline. Fresh gas flow of 1.5 L/min. Study authors report mean (SD) concentration isoflurane at 0.33% (± 0.21%)
Other info: premedication and use of fentanyl same as TIVA group
Inhalational maintenance group (desflurane)
Participants: n = 15; 1 loss (owing to sudden vaporizer failure); 14 analysed
Induction details: propofol 1 mg/kg to 2 mg/kg, fentanyl 1 µg/kg to 2 µg/kg, vecuronium 0.1 mg/kg
Maintenance details: 60% N2O in O2. Desflurane titrated to maintain HR and BP within 20% of baseline. Fresh gas flow of 1.5 L/min. Study authors report mean (SD) concentration desflurane 1.59% (± 1.02)
Other information: premedication and use of fentanyl same as TIVA group
Outcomes

  1. Psychometric evaluation (recovery of cognitive function, assessed with MMSE at time points up to 24 hours)

  2. Sedation scores

  3. Pain measurement

  4. PONV

  5. Postoperative analgesic requirements

  6. Time to discharge from PACU (using Aldrete; minutes)

  7. Time to hospital discharge (days)
Notes Funding/declarations of interest: supported by Pharmacia and Upjohn
Study dates: not reported
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Participants were randomly allocated to groups; no additional information
Allocation concealment (selection bias) Unclear risk No details
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not feasible to blind anaesthetists to intervention groups
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk Outcomes assessed by a single investigator who was blinded to participants' group allocation
Incomplete outcome data (attrition bias) 
 All outcomes Low risk Few participants losses (1 participant in desflurane group, and 1 in propofol group); unlikely to influence outcome data
Selective reporting (reporting bias) Unclear risk Study authors do not report clinical trials registration. Not feasible to judge risk of selective outcome reporting
Other bias Unclear risk Some differences between groups in numbers for each type of surgery. Note balance of gender, with more female participants; balanced between groups and not a risk of bias within the study