Sevoflurane versus desflurane on haemodynamics, arterial oxygenation and pulmonary mechanics in prone position during spinal surgery

Background: This study aimed to compare the effects of equipotent doses (one minimum alveolar concentration) of sevoflurane and desflurane on respiratory mechanics, haemodynamics and oxygenation in patients undergoing spinal surgery in the prone position. Methods: Fifty patients were randomised to receive either sevoflurane (n = 25) or desflurane (n = 25). Respiratory parameters (dynamic compliance (Cdyn); peak (Ppeak), mean (Pmean) and plateau (Pplateau) airway pressures; driving pressure (∆P); tidal volume; and dead space), haemodynamic parameters (heart rate (HR) and systolic, mean and diastolic arterial pressures) and oxygenation parameters were recorded intraoperatively at baseline, after prone positioning, during surgery, and after returning to the supine position. Results: Prone positioning led to significant increases in Ppeak and reductions in Cdyn in both groups (p < 0.05). Although Ppeak, Pmean, Pplateau and ∆P fluctuated intraoperatively, no intergroup differences were detected (p > 0.05). After returning to the supine position, respiratory mechanics approached baseline in both groups. Oxygenation (arterial oxygen pressure), ventilation (arterial carbon dioxide pressure), end-tidal carbon dioxide, and pH remained stable and comparable. Sevoflurane was associated with slightly greater decreases in arterial pressures, whereas HR was similar between groups. Conclusions: Both desflurane and sevoflurane maintained stable intraoperative respiratory mechanics, oxygenation, and haemodynamics in patients without pulmonary disease. Prone positioning increased Ppeak and decreased Cdyn similarly in both groups. Both agents appear safe for spinal surgery in the prone position. Clinical Trial Registration: This study was registered at ClinicalTrials.gov (NCT06118489).

Sevoflurane; Desflurane; Prone position; Spinal surgery; Haemodynamics; Respiratory mechanics; Oxygenation; Anaesthesia

[1] Ho GWK, Thaarun T, Ee NJ, Boon TC, Ning KZ, Cove ME, et al. A systematic review on the use of sevoflurane in the management of status asthmaticus in adults. Critical Care. 2024; 28: 334.

[2] Goff MJ, Arain SR, Ficke DJ, Uhrich TD, Ebert TJ. Absence of bronchodilation during desflurane anaesthesia: a comparison to sevoflurane and thiopental. Anesthesiology. 2000; 93: 404–408.

[3] Khan J, Patel P, Liu M. Desflurane. 2024. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537106/ (Accessed: 02 November 2025).

[4] Wu H, Wang S, Dai FB, Tang CL. Research progress in the clinical application of inhaled anesthetic sevoflurane. Medical Gas Research. 2025; 15: 85–92.

[5] Öztürk MC, Demiroluk Ö, Abitagaoglu S, Ari DE. The effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial. Saudi Medical Journal. 2019; 40: 1235–1241.

[6] Steyl C, Kluyts HL. A randomised controlled trial comparing quality of recovery between desflurane and isoflurane inhalation anaesthesia in patients undergoing ophthalmological surgery at a tertiary hospital in South Africa (DIQoR trial). BJA Open. 2023; 9: 100246.

[7] Nelson A, Sudhakar S, Mishra J, Tirupathi HK, Marella VG, Kudagi VS. Comparison of the sevoflurane versus desflurane anaesthesia on the recovery of airway reflexes and cognitive function: an original research. Journal of Pharmacy & Bioallied Sciences. 2023; 15: S288–S292.

[8] Zhou J, Iwasaki S, Yamakage M. Time- and dose-dependent effects of desflurane in sensitized airways. Anesthesia and Analgesia. 2017; 124: 465–471.

[9] Ebert TJ, Muzi M. Sympathetic hyperactivity during desflurane anesthesia in healthy volunteers. A comparison with isoflurane. Anesthesiology. 1993; 79: 444–453.

[10] Lin HF, Cheng F, Huang M, Wang CZ. Influential factors of early pulmonary complications after laparoscopic surgery in elderly patients. The Journal of Practical Medicine. 2018; 34: 2213–2216. (In Chinese)

[11] Lai C, Monnet X, Teboul JL. Hemodynamic implications of prone positioning in patients with ARDS. Critical Care. 2023; 27: 98.

[12] Kandasamy P, Pujari VS, Channaiah SRD. Effect of spine frame on the changes in respiratory dynamics in prone patients under general anaesthesia—a prospective, observational study. Indian Journal of Anaesthesia. 2023; 67: 609–613.

[13] Palmon SC, Kirsch JR, Depper JA, Toung TJ. The effect of the prone position on pulmonary mechanics is frame-dependent. Anesthesia and Analgesia. 1998; 87: 1175–1180.

[14] Sen O, Bakan M, Umutoglu T, Aydın N, Toptas M, Akkoc I. Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position. SpringerPlus. 2016; 5: 1761.

[15] Aydın BS, Açıkgöz E. Effect of the prone position on mechanical power in elective surgical patients under general anesthesia: a prospective observational study. Saudi Medical Journal. 2024; 45: 814–820.

[16] Ekşi A, Üstün FE, Bilgin S, Kocamanoğlu İS, Şener EB, Sarihasan B. The comparison of effects of sevoflurane and desflurane on respiratory mechanics in smokers and nonsmokers. University of Ondokuz Mayıs Journal of Medicine. 2008; 25: 57–66.

[17] Wiklund CU, Lim S, Lindsten U, Lindahl SG. Relaxation by sevoflurane, desflurane and halothane in the isolated guinea-pig trachea via inhibition of cholinergic neurotransmission. British Journal of Anaesthesia. 1999; 83: 422–429.

[18] Habre W, Peták F, Sly PD, Hantos Z, Morel DR. Protective effects of volatile agents against methacholine-induced bronchoconstriction in rats. Anesthesiology. 2001; 94: 348–353.

[19] Dikmen Y, Eminoglu E, Salihoglu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia. 2003; 58: 745–748.

[20] Sivaci R, Orman A, Yilmazer M, Yilmaz S, Ellidokuz H, Polat C. The effect of low-flow sevoflurane and desflurane on pulmonary mechanics during laparoscopic surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A. 2005; 15: 125–129.

[21] Satoh JI, Yamakage M, Kobayashi T, Tohse N, Watanabe H, Namiki A. Desflurane but not sevoflurane can increase lung resistance via tachykinin pathways. British Journal of Anaesthesia. 2009; 102: 704–713.

[22] Nyktari VG, Papaioannou AA, Prinianakis G, Mamidakis EG, Georgopoulos D, Askitopoulou H. Effect of the physical properties of isoflurane, sevoflurane, and desflurane on pulmonary resistance in a laboratory lung model. Anesthesiology. 2006; 104: 1202–1207.

[23] Kapoor MC, Vakamudi M. Desflurane—revisited. Journal of Anaesthesiology, Clinical Pharmacology. 2012; 28: 92–100.

[24] Camporesi A, Cristiani F, Cruces P, Igarzabal H, Catozzi G, Bayon G, et al. Effect of prone positioning and PEEP on respiratory mechanics in children undergoing scoliosis surgery. Journal of Anesthesia, Analgesia and Critical Care. 2025; 5: 64.

[25] Gattinoni L, Brusatori S, D’Albo R, Maj R, Velati M, Zinnato C, et al. Prone position: how understanding and clinical application of a technique progress with time. Anesthesiology and Perioperative Science. 2023; 1: 3.

[26] Frick AE, Schiefer J, Maleczek M, Schwarz S, Benazzo A, Rath A, et al. The effect of prone positioning after lung transplantation. The Annals of Thoracic Surgery. 2024; 117: 1045–1051.

[27] Jo YY, Kim JY, Kwak YL, Kim YB, Kwak HJ. The effect of pressure-controlled ventilation on pulmonary mechanics in the prone position during posterior lumbar spine surgery: a comparison with volume-controlled ventilation. Journal of Neurosurgical Anesthesiology. 2012; 24: 14–18.

[28] Shanmugam Y, Venkatraman R, Ky A. A comparison of the effects of different positive end-expiratory pressure levels on respiratory parameters during prone positioning under general anaesthesia: a randomized controlled trial. Cureus. 2024; 16: e68693.

[29] Alzahrani HA, Corcione N, Alghamdi SM, Alhindi AO, Albishi OA, Mawlawi MM, et al. Driving pressure in acute respiratory distress syndrome for developing a protective lung strategy: a systematic review. World Journal of Critical Care Medicine. 2025; 14: 101377.

[30] Li X, Xue W, Zhang Q, Zhu Y, Fang Y, Huang J. Effect of driving pressure-oriented ventilation on patients undergoing one-lung ventilation during thoracic surgery: a systematic review and meta-analysis. Frontiers in Surgery. 2022; 9: 914984.

[31] Picker O, Schwarte LA, Schindler AW, Scheeren TW. Desflurane increases heart rate independent of sympathetic activity in dogs. European Journal of Anaesthesiology. 2003; 20: 945–951.

[32] Kao MC, Tzeng IS, Chan HL. Esmolol pretreatment attenuates heart rate increase and parasympathetic inhibition during rapid increases in desflurane concentration: a preliminary randomized study. Medicine. 2017; 96: e8340.

[33] Weiskopf RB, Cahalan MK, Eger EI II, Yasuda N, Rampil IJ, Ionescu P, et al. Cardiovascular actions of desflurane in normocarbic volunteers. Anesthesia and Analgesia. 1991; 73: 143–156.

[34] Lee JW, Kim MK, Kim JY. Hemodynamic responses to 1 MAC desflurane inhalation during anesthesia induction with propofol bolus and remifentanil continuous infusion: a prospective randomized single-blind clinical investigation. BMC Anesthesiology. 2023; 23: 59.

[35] Ebert TJ, Muzi M, Lopatka CW. Neurocirculatory responses to sevoflurane in humans: a comparison to desflurane. Anesthesiology. 1995; 83: 88–95.

[36] Lee JM, Lee SK, Kim KM, Kim YJ, Park EY. Comparison of volume-controlled ventilation mode and pressure-controlled ventilation with volume-guaranteed mode in the prone position during lumbar spine surgery. BMC Anesthesiology. 2019; 19: 133.

[37] Yucepur S, Kepekci AB, Erbin A, Ozenc E. Effects of lithotomy and prone positions on hemodynamic parameters, respiratory mechanics, and arterial oxygenation in percutaneous nephrolithotomy performed under general anesthesia. Folia Medica. 2023; 65: 427–433.

[38] Abraham EA, Verma G, Arafat Y, Acharya S, Kumar S, Pantbalekundri N. Comparative analysis of oxygen saturation by pulse oximetry and arterial blood gas in hypoxemic patients in a tertiary care hospital. Cureus. 2023; 15: e42447.