Comparison of emergence agitation between sevoflurane and desflurane in elderly orthopedic patients: a retrospective cohort study.

BCKGROUND: Emergence agitation frequently occurs during emergence from general anesthesia and may result in potentially serious complications, especially in elderly patients. Although desflurane and sevoflurane are widely used, their differential effects on emergence agitation in elderly populations remain unclear.

METHODS

In this retrospective cohort study, we analyzed 376 elderly patients (≥65 years) who underwent orthopedic surgery under general anesthesia with either sevoflurane or desflurane between August 2022 and February 2024. Propensity score matching (1:1 ratio) was performed to adjust baseline differences. Emergence agitation was defined as Ricker Sedation-Agitation Scale (RSAS) score ≥5 during emergence. Postoperative delirium was diagnosed by psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Multivariable logistic regression was used to identify independent risk factors for emergence agitation.

RESULTS

After matching, 141 patients remained in each group. Emergence agitation occurred significantly more often in the sevoflurane group than the desflurane group (35.5% vs. 12.1%, P<0.001). RSAS scores were also higher in the sevoflurane group (P=0.037). The incidence of postoperative delirium was significantly higher in the sevoflurane group (15.6% vs. 4.3%, P=0.003). Multivariable analysis identified sevoflurane use, spinal surgery, endotracheal intubation, and ASA class III-IV as independent risk factors for emergence agitation.

CONCLUSIONS

In elderly orthopedic patients, sevoflurane was associated with significantly higher rates of emergence agitation and postoperative delirium compared to desflurane. These findings emphasize the importance of individualized anesthetic planning in the elderly, considering anesthetic pharmacological characteristics and identified risk factors of emergence agitation.