Isoflurane et desflurane font l'objet d'une évaluation comparative quant à leur effet hémodynamique et aux conditions de réveil en microchirurgie de l'oreille moyenne. Deux séries de 20 patients sont étudiées. Les conditions hémodynamiques peropératoires et leur corrélation aux concentrations alvéolaires d'anesthésique ne s'avèrent pas significativement différentes. Les conditions de réveil, dépendant surtout de l'usage des ≪ adjuvants ≫ analgésiques utilisés, s'avèrent également statistiquement équivalentes. Le desflurane apparaît devoir être réservé aux patients hémodynamiquement fragiles et classés dans le domaine du risque au-delà de ASA 2.

Two series of twenty patients ASA 1 or 2 were scheduled to undergo middle ear surgery. Anesthesia was induced with Etomidate: 0.4 mg.k-1, Atracurium: 0,5 mg.k-1, Alfentanil bolus 25 μg.k-1. min-1. Patients were allocated randomely to receive either inhalation of Isoflurane or Desflurane in order to obtain amean arterial pressure (MAP) close to 60 mmHg. MAP and FA anesthetic were recorded during the opération to establish a possible correlation between the 2 parameters. After the switch off the vaporizer, awakenning conditions were noted: spontaneous ventilation time; extubation time; spontaneous opening of the eyes,; temro-spatial recovery allowing the patients to leave the recovery room. Résults: No statistical difference in hemodynamic conditions was observed mid-operation, but there was a better correlation between MAP and FA in the Desflurane group.No statistical difference was observed in the awakening period: Spontaneous ventilation time: Isoflurane: 37 min 16 versus Desflurane: 28,5 min ±16-Extubation time: Isoflurane: 61.5 min 23 versus Desflurane: 60,9 min 8- Spontaneous opening of the eyes: Isoflurane: 44.6 min ±22 versus Desfurane: 36.8 min ±21 -Recovery time: Isoflurane: 82.9 min ± 63 versus Desflurane: 72.8 min +/6 49. The vomiting reaction was more frequent in the Desfurane group (30%) than in the Isoflurane one (15%). length of the stay in the recovery room depends more on Morphinomimetic drugs than on inhalational anesthetics. We prefer a calm and painless awakening rather than the need to give morphinomimetic after anesthesia. The good correlation between MAP and FA Desflurane is the witness of its manoeuvrability. This anesthetic is well-suited to weak patients.