Comparison of the Effects of Desflurane, Sevoflurane, and Propofol on the Glottic Opening Area during Remifentanil-Based General Anesthesia Using a Supraglottic Airway Device.

Purpose: The aim of this study was to compare the effects of desflurane, sevoflurane, and propofol on the glottic opening area during general anesthesia using remifentanil.

Methods: Ninety patients undergoing hand and upper limb surgery combined with brachial plexus block under general anesthesia were enrolled in the study. The patients were randomized into three groups to receive desflurane (group D), sevoflurane (group S), or propofol (group P) for maintenance of anesthesia. Following induction of general anesthesia with remifentanil, continuous fiberoptic video recording around the glottis via an i-gel™ supraglottic device was started after establishing mechanical ventilation. Desflurane, sevoflurane, or propofol was administrated after video recording was started. The changes in normalized glottic opening area (n-GOA) and peak inspiratory pressure (PIP) during surgery were compared between the three groups.

Results: Intraoperative changes of n-GOA in group D showed significant differences compared with group S and group P (-0.0656 ± 0.0772 vs. -0.0076 ± 0.0499 and +0.0269 ± 0.0809, P=0.005 and P < 0.0001). The changes of PIP in group D showed significant differences compared with group S and group P (+3.7 ± 3.4 cmH₂O vs. +1.0 ± 1.3 cmH₂O and -0.3 ± 3.6 cmH₂O, P=0.002 and P < 0.0001). Four cases of relapsed glottic stenosis in group D were improved by changing desflurane to propofol.

Conclusions: Desflurane narrowed the n-GOA and increased the PIP compared to sevoflurane and propofol during general anesthesia with remifentanil. Clinicians should be aware of the possibility of glottic stenosis during desflurane-remifentanil anesthesia when the airway is secured by a supraglottic airway device without the use of neuromuscular blockade.