Abstract: Objective  To compare the effects of desflurane inhalation anesthesia versus propofol total intravenous anesthesia on postoperative recovery quality in patients undergoing endoscopic transnasal pituitary adenoma resection, and to provide evidence-based recommendations for optimizing anesthetic management in this surgical population. Methods  This single-center, prospective, randomized controlled trial enrolled 112 patients scheduled for endoscopic transnasal pituitary adenoma resection, who were randomly assigned to either the desflurane group (n=56) or the propofol group (n=56). The desflurane group received desflurane ［0.7-1.0 minimum alveolar concentration（MAC)］　combined with remifentanil for anesthesia maintenance, whereas the propofol group received propofol (4-6 mg·kg^-1·h^-1) with remifentanil. The primary outcome was defined as the time from discontinuation of anesthetics to achieving an Aldrete score of 9. Secondary outcomes included emergence time, extubation time, and incidences of postoperative agitation and vomiting. Results  Patients receiving desflurane achieved an Aldrete score of 9 significantly faster than those in the propofol group (13.0 min vs 16.5 min, P=0.003). Similarly, both emergence time (14.0 min vs 16.5 min, P=0.009) and extubation time (13.0 min vs 16.5 min, P=0.003) were significantly shorter in the desflurane group. However, the desflurane group had higher incidences of postoperative agitation (17.9% vs 3.6%, P=0.015) and vomiting (19.6% vs 5.4%, P=0.022). No significant difference was observed in severe agitation rates or 24 h postoperative recovery quality ［Quality of Recovery-15（QoR-15） scores］ between groups. Conclusion  Desflurane anesthesia significantly accelerates postoperative recovery in patients undergoing endoscopic transnasal pituitary adenoma resection, however, it may increase risks of mild agitation and vomiting. In clinical applications, it is necessary to balance recovery benefits against potential adverse effects, and take targeted prophylactic measures.

Key words: perioperative management, desflurane, propofol, pituitary adenoma, neurosurgery, quality of perioperative recovery