Comparison of Sevoflurane and Desflurane with Dexmedetomidine for Recovery in Neurosurgical Patients Undergoing Supratentorial Tumor Surgery

Background: Anesthetic management in neurosurgical procedures requires rapid recovery and stable hemodynamics to enable early neurological evaluation. Sevoflurane and desflurane, with low blood–gas solubility, are commonly used inhalational agents. Dexmedetomidine, an α2-adrenergic agonist, provides sedation and hemodynamic stability. Limited studies have compared sevoflurane and desflurane in combination with dexmedetomidine for neurosurgical recovery. Aims and Objectives: To compare the recovery profile, cognitive function, and intraoperative brain relaxation in patients undergoing supratentorial tumor surgery under sevoflurane–dexmedetomidine versus desflurane–dexmedetomidine anesthesia. Materials and Methods: This prospective observational study was conducted at Kasturba Medical College, Mangalore, between March 2023 and August 2024. Ninety-six patients aged 40–65 years undergoing elective supratentorial craniotomy were enrolled and divided into two groups: Group A (sevoflurane with dexmedetomidine) and Group B (desflurane with dexmedetomidine). Recovery times (emergence, extubation, orientation), cognitive function (Short Orientation Memory Concentration Test, SOMCT), brain relaxation score, hemodynamics, and adverse events were assessed. Data were analyzed using independent t-tests and Chi-square tests, with P < 0.05 considered significant. Results: Desflurane group showed significantly shorter emergence (8.1 ± 1.4 vs. 12.9 ± 1.2 min), extubation (13.9 ± 2.8 vs. 18.8 ± 1.3 min), and orientation times (36.2 ± 4.8 vs. 41.6 ± 4.3 min) compared to sevoflurane (P < 0.001). Cognitive recovery was faster with desflurane (SOMCT 7.8 ± 1.6 vs. 13.2 ± 3.0; P < 0.001). Brain relaxation was superior in the desflurane group (P < 0.001). Adverse events were fewer with desflurane (4.2% vs. 20.8%; P = 0.01). Hemodynamics remained stable in both groups. Conclusion: Desflurane with dexmedetomidine provides faster emergence, better cognitive recovery, superior brain relaxation, and fewer adverse events compared to sevoflurane in supratentorial neurosurgery. It may be preferred when rapid postoperative neurological assessment is required.