General Anaesthesia allows ventilation and oxygenation as well as a mode for anesthetic gas delivery. General anaesthesia may be induced and maintained by a number of drugs, depending on the condition of the patient and the anesthetist’s preference. The airway might be secured using a face mask, laryngeal mask or endotracheal tube and ventilation could be spontaneous or mechanical.1

Majority cancers of head and neck occur after exposure to carcinogens such as tobacco and alcohol. They are usually squamous cell carcinomas and they develop in the upper respiratory-digestive tract epithelium. The complicated anatomy and important physiological function of tissues implicated in these tumours mandate that the treatment's objectives is not just to increase survival rates but also to maintain organ function.2

For the patient scheduled for head and neck cancer surgery, a thorough evaluation of the airway reveals the best strategy for securing the airway before surgery to be performed. Before the trachea is intubated, the patient is usually anaesthetized. The patient might need to be sedated and given topical analgesics during an awake fiberoptic intubation for the evaluation of the airway before general anesthesia is induced.3 In some cases, a tracheostomy may be required to maintain the airway. Extubation of the trachea following surgery necessitates meticulous attention and may be more difficult than initial intubation. Avoiding the airway issues linked to this sort of surgery is of utmost importance.

Head and neck cancer surgeries are often complex and require meticulous planning and management, especially during the perioperative period. General anesthesia is a crucial component of these surgeries, ensuring that patients remain unconscious and pain-free throughout the procedure. Among the various anesthetic agents available, inhalational anesthetic agents are commonly used due to their rapid onset, ease of titration and ability to maintain stable hemodynamics.4 However, the choice of anesthetic agent can significantly influence the emergence and recovery profiles, which are critical factors in the overall outcome of surgery.

The choice between desflurane and isoflurane in head and neck cancer surgeries under general anesthesia is a critical decision that can impact the speed and quality of recovery. By conducting a randomized controlled trial, this study aims to provide robust evidence to guide anesthetic choices in this challenging surgical population, ultimately improving patient care and outcomes in cancer surgery of head and neck.

This Randomized controlled study was conducted in Department of Anaesthesiology, Rohilkhand Medical College and Hospital, Bareilly after obtaining Institutional Ethical Committee’s approval. Duration of Study was One year from August 2023 to July 2023

Subjects: Patients posted for cancer surgery of the head and neck region. Patients were divided in two groups-

Group 1: GA with Desflurane as maintenance agent

Group 2: GA with Isoflurane as maintenance agent

Sample Size: In this study, patients were randomly divided into two groups to do the comparison. Sample size is taken to be 50 in each group as per statistical calculations which is done by using the software - Power and Sample size program

Inclusion criteria:

Patients fulfilling the following:

1. 5American society of Anesthesiologist (ASA) grade II and III
2. 6Between 18-60 years of age
3. Patients of either sex
4. 7Mallampatti grade I, II, III and IV
5. Duration of surgery being more than 3 hours.

Exclusion criteria:

1. Emergency surgeries
2. Non-consenting patients
3. Full stomach patients
4. Patients with cardiovascular diseases and uncontrolled hypertension.
5. Patients with high intra cranial pressure (ICP).
6. Patients on chronic opioid therapy

Methodology

The methodology of the study was designed according to the ethical principles outlined in the Declaration of Helsinki for medical research involving human subjects. After taking a written and informed consent from the patients who had been chosen for screening while undertaking elective cases requiring general anesthesia for more than 3 hour, a randomized control study was carried out in Rohilkhand Medical College and Hospital Bareilly on total of 100 patients of ASA physical status class 2 and 3 of either sex, in age group of 18 to 60 years.

Participants were randomly divided into two groups:

Group 1 and Group 2.

Group 1 received inhalational anesthesia with Desflurane/Nitrous oxide/Oxygen, while Group 2 received inhalational anesthesia with Isoflurane/Nitrous oxide/Oxygen as maintenance for general anesthesia in patients with difficult airways.

Prior to the procedure, a thorough history and evaluation of the cardiovascular, pulmonary, and central nervous systems was performed. The risk of a challenging intubation was checked with an evaluation of the airways. Every positive finding from the history and examination was noted on a pre-designed and pre-tested performa.

After all routine investigations were carried out, the anesthesia procedure was described to every patient, and signed consent was obtained. Before surgery, the patient was kept NPO for eight hours. NPO status was verified in the morning, at the point where patient was transported to preoperative room.

The systolic blood pressure, diastolic blood pressure, MAP and HR of the patient was noted. The patients were divided in two groups at random and all patients were pre- medicated with Tablet Ranitidine Hydrochloride (150 mg HS and 6 AM) and Tablet Alprazolam (0.5 mg HS and 6 AM).

On the day of surgery, intravenous fluid was initiated 30 minutes before the procedure, and Injection Glycopyrrolate 0.2 mg intramuscularly was administered. Baseline readings of heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and arterial O2 saturation were recorded after the patient was connected to monitors.

Patient were pre medicated with 4ml of 4% Lignocaine nebulization 30 minutes before surgery, Xylomethazoline nasal drops on each nostril and Injection Midazolam 1mg intravenous. Induction was done with Injection Propofol (2.0 mg/kg) intravenous, Injection Fentanyl citrate (2 μg/kg) intravenous and Injection Succinylcholine (1.5mg/ kg) intravenous to accomplish muscle relaxation. Endotracheal Intubation (nasal) was done using standard protocol/technique with indirect laryngoscopy (fiberoptic) with flexometallic endotracheal tube.

Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, arterial O2 saturation, end-tidal CO2 concentration, was recorded every 5 minute after induction till 1 hour and then every 15 minutes until the end of anaesthesia. The inspired concentration of volatile anaesthetic agents was adjusted to achieve an end tidal concentration of 1 MAC in a total gas flow of 2 liter/minute. Acute hemodynamic changes (±20%of baseline) were managed by a 25% change in end tidal concentration of volatile agent.

Injection Paracetamol intravenous (15-20mg/kg) was administered 30 minutes prior to end of surgery. Maintenance with O2 and N2O in the ratio 40:60, Isoflurane or Desflurane and Injection Vecuronium (intubating dose 0.12mg/kg and maintenance dose as 0.01mg/kg) was used to maintain anaesthesia.

Normocarbia was maintained during the procedure using a closed-circuit system with a total fresh gas flow rate of 2 L/min, and surface warming and fluid warmer were used to prevent hypothermia, with the optimal operating room temperature maintained between 25-28°C.

At the conclusion of the surgery, Isoflurane or Desflurane was discontinued at completion of skin closure. The patients were were ventilated with 100% O2 at a flow rate of 10 L/min. Neuromuscular blockade was reversed using Injection Neostigmine bromide (0.05 mg/kg) and Injection Glycopyrrolate (0.01 mg/kg) intravenously. The times from discontinuing of inhalational agent to swallowing, spontaneous eye opening, limb movements, establishment of regular spontaneous breathing pattern, respond to verbal commands (eye-opening/ tongue protrusion), tracheal extubation, obeying commands (e.g., squeezing the investigator’s hand), as well as the time to orientation to name, were assessed at 30–60 second intervals. The durations of anesthesia (from the start of induction to discontinuation of inhalational agent) were recorded. Pharyngo- tracheal suction was performed, followed by extubation.

The amount of fluid administered and blood loss were assessed. All indices related to emergence were meticulously recorded and entered into the designated proforma.

The study focused on comparing "immediate recovery" indices between the two groups.

1. Time to readiness for extubating -
   • Time to spontaneous movement (swallowing, spontaneous eye opening, limb movements) from time of discontinuation of inhalation anaesthetic agent
   • Time to establishment of regular spontaneous breathing pattern

• Time to respond to verbal commands (eye-opening/ tongue protrusion)

2. Time to extubation
3. Time for readiness to shift patient to post operative care unit (from time of discontinuation of inhalation anaesthetic agent)
   • Time to state name on command
   • Time taken to squeeze the examiners fingers on command

After the patient can keep his eyes open, elevate head and breathe normally, he/she was shifted to post-operative care unit. Any complications/adverse event like nausea- vomiting, desaturation, breath holding etc. up to 1 hour postoperatively were noted.

Following indices for Intermediate recovery from anaesthesia were recorded as follows:

Time to discharge from post-anaesthetic-care unit (PACU)- Was determined by Modified Aldrete Recovery Score (MARS) which was measured every 5 minutes from the time of the patient getting shifted to post anaesthetic care unit (PACU) until optimal score (score > 9) was achieved.

Statistical Analysis: The data were entered on a Microsoft Excel spreadsheet and imported into Statistical Package for Social Sciences (SPSS) version 23 for statistical analysis. Qualitative data was present in frequency and percentage and quantitative data was presented in mean and standard deviation. A chi- square test was performed to find associations in different variables between the 2 groups, and student independent t-test was performed.

Table 1: Demographic data and Duration of Anaesthesia

The mean age for patients receiving Desflurane was 45.4 years with a standard deviation of 15.6, and for Isoflurane, the mean age was 44.8 years. This suggests that the age distribution between the two groups was comparable. p-value of 0.>0.05

The sex ratio also showed a slight variation, with Group A- Desflurane having a male to female ratio of 2.06:1 and Group B- Isoflurane a ratio of 1.53:1. (p-value of 0.>0.05)  Therefore, the difference in the male-to-female ratio between the two groups is likely due to random chance and is not statistically significant.

Lastly, the duration of anesthesia averaged 279 minutes (±23.3) for Desflurane and 281 minutes (±20.3) for Isoflurane. p-value of 0.>0.05  These values collectively confirm that the two groups were demographically and procedurally comparable, which is critical for the validity of comparing the effects of Desflurane and Isoflurane on emergence and recovery times.

Analysis of heart rate (HR) data across various time points during cancer surgeries of head and neck under general anesthesia with Desflurane and Isoflurane reveals some subtle differences, though many are not statistically significant. At various intervals during the surgery (e.g., at time of intubation, 5, 10, 15 minutes, etc.), Desflurane generally exhibits a higher mean HR compared to Isoflurane, though the differences are often minimal. For example, at 60 minutes, a significant result (p =0.032) shows Desflurane with a higher HR (mean 81.2) compared to Isoflurane (mean 76.8). However, at 25 minutes, the roles reverse with Isoflurane showing a slightly higher HR, but the difference is not significant (p-value of >0.05). Across the entire duration, the mean HR under Desflurane tends to be higher more frequently at the measured time points, suggesting a trend where Desflurane may be associated with a higher sympathetic tone. Despite these differences, none are pronounced enough to clearly favor one agent significantly over the other across all time points.

Graph 1: Comparison of Heart Rate at different times within Desflurane and Isoflurane groups

Analysis of systolic blood pressure (SBP) values during head and neck cancer surgeries under general anesthesia with Desflurane and Isoflurane demonstrates closely matched performance between the two groups across various time points, with only a few statistically significant differences.

Throughout the surgery, both inhalational anesthetics consistently maintain SBP within a similar range, with minimal fluctuations and no significant differences at most assessed intervals. The 20-minute mark and 180-minute mark stands out, where Desflurane records a significantly lower SBP (p = 0.734) and (p = 0.734) respectively, indicating a momentary differential impact on blood pressure control compared to Isoflurane. Whereas the 50-minute mark for Desflurane and 120,180-minute mark for Isoflurane stands out, where Desflurane records a higher SBP (p = 0.614), and Isoflurane also records a significantly higher SBP ((p = 0.286) and (p=0.734) respectively).

Despite these isolated instances of statistical significance, the overall pattern reflects that neither Desflurane nor Isoflurane consistently outperforms the other in terms of maintaining stable SBP throughout the surgical procedure. Both agents prove effective while showing slight variability at specific points, which cannot be considered clinically relevant.

Graph 2: Comparison of SBP at different time points within Desflurane and Isoflurane groups

Analysis of diastolic blood pressure (DBP) measurements for patients undergoing head and neck cancer surgeries under general anesthesia with Desflurane and Isoflurane reveiling largely equivalent performance between the two inhalational anesthetic agents across various time points, with only one significant finding. Generally, the DBP for both groups fluctuates within a close range without significant differences, suggesting that both anesthetics are similarly effective in maintaining diastolic blood pressure stability during surgery. A notable difference occurs at the 40-minute mark, where Desflurane shows a significantly higher DBP compared to Isoflurane (p = 0.08), indicating a potential advantage of Desflurane in maintaining higher diastolic pressure during this early surgical phase. Aside from this instance, the p-values at other time intervals signifying no statistically significant differences. Overall, while Desflurane and Isoflurane both provide effective control of DBP, the slight differences are not consistent enough to decisively favor one agent over the other across the entire duration of surgery. The choice between Desflurane and Isoflurane should therefore consider additional factors, as both agents are competent in managing DBP

Graph 3: Comparison of DBP at different time points within Desflurane and Isoflurane groups

Analysis of mean arterial pressure (MAP) values during head and neck cancer surgeries under general anesthesia where Desflurane and Isoflurane demonstrates closely matched performance between the two groups across various time points, with only a few statistically significant differences. Throughout the surgery, both inhalational anesthetics consistently maintain MAP within a similar range, with minimal fluctuations and no significant differences at most assessed intervals. Despite these isolated instances of statistical significance, the overall pattern reflects that neither Desflurane nor Isoflurane consistently outperforms the other in terms of maintaining stable MAP throughout the surgical procedure. Both agents prove effective while showing slight variability at specific instances, which cannot be considered clinically relevant.

Graph 4: Comparison of MAP at different time points within Desflurane and Isoflurane groups

Table 2: Comparison of recovery parameters at different time points within group

For all measured recovery parameters, Desflurane demonstrated significantly faster recovery times than Isoflurane, with p-values < 0.001 across the board. The mean time for spontaneous eye opening was 4.5 minutes with Desflurane, compared to 8.04 minutes for Isoflurane. Similarly, swallowing reflex returned in 4.54 minutes with Desflurane and 8.23 minutes with Isoflurane. Times for head raising and tongue protrusion were also quicker with Desflurane, averaging 4.31 and 4.62 minutes, respectively, compared to 8.6 and 8.44 minutes for Isoflurane. Normal breathing resumed at 4.56 minutes for Desflurane versus 8.42 minutes for Isoflurane. The ability to respond to a name command and squeeze the examiner’s finger occurred at 8.1 and 8.08 minutes, respectively, for Desflurane, while Isoflurane required 14.73 and 14.69 minutes. Finally, extubation was achieved faster with Desflurane (6.38 minutes) compared to Isoflurane (14.31 minutes). These findings indicate that Desflurane facilitates significantly faster recovery and responsiveness post- anesthesia compared to Isoflurane, making it potentially more favorable in surgeries requiring rapid recovery.

Table 3: Comparison of PACU & recovery parameters

Patients in the Desflurane group (Mean = 12.17 minutes, SD = 2.431) were shifted to the PACU significantly faster than those in the Isoflurane group (21.38 minutes, SD = 2.218) p- value = < 0.001.

This suggests that Desflurane enables quicker recovery and transfer to the PACU. However, there was no significant difference in the time to discharge from the PACU between the two groups. p-value of 0.>0.05 indicating similar overall recovery quality (including parameters like consciousness, activity, respiration, circulation, and oxygen saturation) after anesthesia.

This randomized controlled trial aims to directly compare the choice between desflurane and isoflurane in head and neck cancer surgeries under general anesthesia, as it is a critical decision that can impact the speed and quality of recovery. This study aims to provide robust evidence to guide anesthetic choices in this challenging surgical population, ultimately improving patient care and outcomes in cancer surgery patients of head and neck.

In our study, total 100 patients were taken and randomly divided into two groups to compare Desflurane (Group 1) and Isoflurane (Group 2) as maintenance agents during general anaesthesia for cancer surgeries of head and neck lasting more than three hours.

The mean age of patients was similar between the groups (Desflurane: 45.4 ± 15.6 years, Isoflurane: 44.8 ± 13.2 years, p = 0.828). The sex ratio showed a male predominance in both groups, with a ratio of 2.06:1 for Desflurane and 1.53:1 for Isoflurane (p = 0.473) as the incidence of tobacco chewing is higher in males compared to females. These findings indicate no statistically significant differences in demographic parameters or anaesthesia duration between the groups.

These findings were compared with the study of Steyl C et al.8, who evaluated 80 patients under Desflurane and 84 under Isoflurane. In their study, the median age for Desflurane patients was 36 years (IQR 27–50) compared to 42 years (IQR 28–56) for Isoflurane, slightly younger than the patients in our study. Gender distribution showed a male predominance (Desflurane: 59%, Isoflurane: 68%), which aligns with the male predominance observed in our cohort. However, their reported anaesthesia durations (Desflurane: 72 minutes, Isoflurane: 80 minutes) were significantly shorter than those in our study due to differences in surgical complexity.

In our study, we compared heart rates at various perioperative time points between patients receiving Desflurane and Isoflurane. Heart rate (HR) data across various time points during cancer surgeries of head and neck under general anesthesia with Desflurane and Isoflurane reveals some subtle differences, though many are not statistically significant. At various intervals during the surgery (e.g. 5, 10, 15 minutes, etc.), Desflurane generally exhibits a higher mean HR compared to Isoflurane, though the differences are often minimal and within acceptable clinical range. Across the entire duration, the mean HR under Desflurane tends to be higher more frequently at the measured time points, suggesting a trend where Desflurane may be associated with a higher sympathetic tone. Despite these differences, none are pronounced enough to clearly favor one agent significantly over the other across all time points.

When compared to the findings of Bhagat et al.9, who observed similar heart rates between Propofol and Desflurane groups during the perioperative period, our study demonstrated a clear alignment with findings of Isoflurane and Desflurane with no significant differences between groups in terms of heart rates in the perioperative period.

Gollapudy et al.10 found no significant differences in heart rates between groups using Desflurane (67.4 ± 7.5 bpm), combination agents (67.6 ± 10.4 bpm), and TIVA (69.7 ± 11.0 bpm, p = 0.69). While their study showed stable heart rates with Desflurane, the absolute values were slightly lower even though not clinically significant compared to our findings.

In our study, systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were compared between Desflurane and Isoflurane groups at various perioperative time points during cancer surgeries of head and neck. Preoperatively, SBP levels were similar between the two groups, along with DBP levels. Throughout the surgery, both inhalational anesthetics consistently maintain SBP and DBP within a similar range, with minimal fluctuations and no significant differences at most assessed intervals. Despite some isolated instances of statistical significance, the overall pattern reflects that neither Desflurane nor Isoflurane consistently outperforms the other in terms of maintaining stable SBP and DBP throughout the surgical procedure. Both agents prove effective, and the choice between these two should, therefore, consider additional clinical factors beyond SBP and DBP control, as both are capable of effectively managing this parameter.

When compared to previous studies, our findings align with those of Verma et al.11, who reported stable SBP and DBP levels in the Desflurane group throughout the perioperative period. They observed SBP and DBP values ranging from 126.44 ± 9.69 mmHg pre induction to 121.08 ± 15.55 mmHg at 5 hours, with no significant differences between groups. Coinciding with our study, that neither Desflurane nor Isoflurane consistently outperforms the other in terms of maintaining stable SBP and DBP throughout the surgical procedure. Both agents prove effective.

In our study, mean arterial pressure (MAP) was compared between Desflurane and Isoflurane groups during cancer surgeries of head and neck. Throughout the surgery, both inhalational anesthetics consistently maintain MAP within a similar range, with minimal fluctuations and no significant differences at most assessed intervals. Despite some isolated instances, the overall pattern reflects that neither Desflurane nor Isoflurane consistently outperforms the other in terms of maintaining stable MAP throughout the surgical procedure. These findings suggest that both agents provides similar intraoperative hemodynamic stability.

Bhagat et al.9 analyzed MAP trends and found a significant rise in MAP in the Propofol group 30 minutes post-incision compared to the Desflurane group. However, this rise was not deemed clinically significant. Both groups experienced transient MAP increases during the periextubation phase, with no significant differences in vasomotor responses to surgical stimuli during tumor resection. This finding aligns with our study, where Desflurane and Isoflurane maintained stable MAP levels across all measured time points.

Immediate recovery parameters

In our study, recovery parameters, including spontaneous eye opening, swallowing, head raising, tongue protrusion, normal regular breathing, name response on command, finger squeezing, and time to extubation, were assessed to compare recovery times between the Desflurane and Isoflurane groups. Across all parameters, Desflurane demonstrated significantly shorter recovery times. Spontaneous eye opening occurred at a mean time of 4.5 minutes in the Desflurane group compared to 8.04 minutes in the Isoflurane group (p < 0.001). Similarly, swallowing was achieved at 4.54 minutes in the Desflurane group compared to 8.23 minutes for Isoflurane (p < 0.001). Extubation was also significantly faster in the Desflurane group, with a mean time of 6.38 minutes compared to 14.31 minutes in the Isoflurane group (p < 0.001). These results highlight that Desflurane facilitates a quicker return to normal protective reflexes and overall recovery.

Steyl C et al.8 reported that the time in the recovery room for the Desflurane group was 18 minutes (95% CI: 13–23), which was significantly shorter than 25 minutes (95% CI: 19–32) for the Isoflurane group (p < 0.001). This aligns with our results, which showed significantly faster extubation and other recovery milestones with Desflurane.

The comparative advantages of desflurane over other anesthetic agents, with a focus on recovery and emergence was also studied by J. Jakobsson et al.12 where they concluded that the extubation time was faster with desflurane (5 ± 1 min) compared to isoflurane (9 ± 1 min) (P < 0.05), J. Dupont et al.13 where they concluded that emergence was twice as fast with desflurane compared to sevoflurane or isoflurane, Chen Xiaoguang et al.14 where Desflurane was associated with faster cognitive recovery compared to Sevoflurane . Although their study used Sevoflurane as the comparator, the findings support our results, as Desflurane consistently exhibited faster emergence and recovery times. , Heavner J. E. et al.15 where Desflurane resulted in faster early recovery than sevoflurane in older individuals undergoing prolonged surgeries.

Concisely , the shorter recovery times observed in our study for Desflurane are supported by similar findings in above studies. These findings are in agreement with our results, which showed that Desflurane significantly outperformed Isoflurane across all recovery parameters. Desflurane’s ability to enable faster extubation, emergence, and recovery of protective reflexes makes it a superior choice for procedures requiring rapid recovery, such as cancer surgeries of head and neck. These consistent results across various studies emphasize the advantages of Desflurane in facilitating early postoperative recovery.

In our study, the time to shift patients to the PACU was significantly shorter in the Desflurane group compared to the Isoflurane group. Patients in the Desflurane group (Mean = 12.17 minutes, SD = 2.431) were shifted to the PACU significantly faster than those in the Isoflurane group (21.38 minutes, SD = 2.218) p-value = < 0.001. Suggesting that Desflurane enables quicker recovery and transfer to the PACU. However, there was no significant difference in the time to discharge from the PACU between the two groups. Both Desflurane and Isoflurane (Mean = 79.77 minutes, SD = 11.068; Mean = 78.65 minutes, SD = 11.723 respectively) with p-value = 0.623 showing similar recovery time post-anesthesia in terms of PACU discharge. In terms of MARS score there was no significant difference between the two groups (p-value = 0.704), indicating similar overall recovery quality after anesthesia. In conclusion, these results indicate that while Desflurane enables a faster transfer to the PACU, the overall recovery and discharge parameters were similar between the two groups.

Gupta P et al.16 demonstrated that the time to attain a “ready to discharge” status from the PACU was significantly shorter in the Desflurane group compared to the Sevoflurane group. In their study, the Modified Aldrete Score (MAS) and the time to achieve full MAS were comparable between the two groups, consistent with our findings that MARS scores did not differ significantly between the Desflurane and Isoflurane groups.

In conclusion, our study findings are consistent with prior research, such as that of Gupta P et al.16, Locatelli et al.17 Desflurane significantly reduces the time to PACU transfer but does not impact the overall time to discharge or recovery scores compared to Isoflurane. This reinforces Desflurane’s utility in surgical scenarios requiring rapid initial recovery while maintaining comparable intermediate recovery outcomes.

esflurane and Isoflurane provided hemodynamic stability, maintaining stable heart rate, systolic, diastolic, and mean arterial pressures throughout the surgery, especially during the critical post-intubation period.

In head and neck cancer surgeries lasting three hours or more, desflurane has been shown to facilitate faster recovery compared to isoflurane because of its pharmacokinetic properties which allow for a more predictable and expedited recovery, which is particularly beneficial in lengthy surgical procedures.

The rapid elimination of desflurane enables patients to regain consciousness and protective reflexes sooner, with faster times to spontaneous eye opening, swallowing, head raising, tongue protrusion, and normal breathing. Desflurane facilitated quicker extubation and earlier responsiveness to commands, highlighting its role in promoting faster neurological recovery post-anesthesia. Timely recovery enables earlier removal of the endotracheal tube, minimizing potential complications associated with prolonged intubation and delayed recovery, including laryngeal injury and ventilator-associated pneumonia. Therefore, in head and neck cancer surgeries extending beyond three hours, desflurane may be a preferable anesthetic choice in comparison to Isoflurane to enhance early postoperative recovery.

Early recovery also permits healthcare providers to more effectively assess and monitor the patient's airway status. This is particularly important in head and neck surgeries with prolonged duration, where postoperative swelling or bleeding can compromise the airway.

Patients who were administered Desflurane were shifted to the PACU significantly earlier than those receiving Isoflurane, reflecting more efficient and faster neurological recovery post-anesthesia..While discharge times from the PACU and Modified Aldrete Recovery Scores were comparable between the groups, Desflurane showed a trend toward reduced recovery time, which could be clinically advantageous in prolonged head and neck cancer surgeries surgeries lasting three hours or more.

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