Comparison of the effects of intravenous propofol and inhalational desflurane on the quality of early recovery after hand-assisted laparoscopic donor nephrectomy: a prospective, randomised controlled trial

Park, Jaesik; Kim, Minhee; Park, Yong Hyun; Shim, Jung Ho; Lee, Hyung Mook; Kim, Yong-Suk; Moon, Young Eun; Hong, Sang Hyun; Chae, Min Suk

doi:10.1136/bmjopen-2020-039881

Cited by 7 publications

(7 citation statements)

References 45 publications

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“…alize. Additionally, unlike this study, our study found a transient but significant improvement in early postoperative recovery in the TIVA group, consistent with several previous studies [22][23][24][25].…”

Section: Discussionsupporting

confidence: 92%

“…Furthermore, this difference did not remain at 72 h postoperatively. There was no significant difference https://doi.org/10.4097/kja.23083 Several studies have investigated the effect of general anesthetic techniques on postoperative recovery using the QoR-40 [22][23][24][25][26][27][28]. An RCT including female patients undergoing thyroid surgery reported the superiority of propofol-based TIVA for early postoperative recovery, mainly due to the reduction in PONV [22].…”

Section: Discussionmentioning

confidence: 99%

“…An RCT including female patients undergoing thyroid surgery reported the superiority of propofol-based TIVA for early postoperative recovery, mainly due to the reduction in PONV [22]. However, differences in patient characteristics and insufficient PONV prophylaxis made this result difficult to apply to other surgeries, and subsequent RCTs have yielded conflicting results [23][24][25][26][27][28]. Moreover, in most previous studies, outcomes were assessed only within POD 1, except in two recently published RCTs [27,28].…”

Section: Discussionmentioning

confidence: 99%

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Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy

Yoon¹,

Joo²,

Yoon³

et al. 2024

Korean J Anesthesiol

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Background: General anesthetic techniques can affect postoperative recovery. We compared the effect of propofol-based total intravenous anesthesia (TIVA) and desflurane anesthesia on postoperative recovery.Methods: In this randomized trial, 150 patients undergoing robot-assisted or laparoscopic nephrectomy for renal cancer were randomly allocated to either the TIVA or desflurane anesthesia (DES) group. Postoperative recovery was evaluated using the Korean version of the Quality of Recovery-15 questionnaire (QoR-15K) at 24 h, 48 h, and 72 h postoperatively. A generalized estimating equation (GEE) was performed to analyze longitudinal QoR-15K data. Fentanyl consumption, pain severity, postoperative nausea and vomiting, and quality of life three weeks after discharge were also compared.Results: Data were analyzed for 70 patients in each group. The TIVA group showed significantly higher QoR-15K scores at 24 and 48 h postoperatively (24 h: DES, 96 [77, 109] vs. TIVA, 104 [82, 117], median difference 8 [95% CI: 1, 15], P = 0.029; 48 h: 110 [95, 128] vs. 125 [109, 130], median difference 8 [95% CI: 1, 15], P = 0.022), however not at 72 h (P = 0.400). The GEE revealed significant effects of group (adjusted mean difference 6.2, 95% CI: 0.39, 12.1, P = 0.037) and time (P < 0.001) on postoperative QoR-15K scores without group-time interaction (P = 0.051). However, there were no significant differences in other outcomes, except for fentanyl consumption, within the first 24 h postoperatively.Conclusions: Propofol-based TIVA showed only a transient improvement in postoperative recovery than desflurane anesthesia, without significant differences in other outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy

Yoon¹,

Joo²,

Yoon³

et al. 2024

Korean J Anesthesiol

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“…According to these properties of TIVA, several works were conducted to demonstrate that TIVA allowed better surgical visibility during ESS compared with IA, even if when stratifying results according to different intraoperative visibility scales and different inhaled anesthetic agents; these findings were not consistent (11,(18)(19)(20). On the other hand, more recent studies focusing on the quality of recovery in patients undergoing surgery comparing the TIVA versus IA, not only in the ear-nose-throat field, confirmed the best recovery in the TIVA groups (21)(22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Effects of Total Intravenous Versus Inhalational Anesthesia on Bleeding During Endoscopic Ear Surgery: Preliminary Results From a Case-Control Study

et al. 2023

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Objective: To assess the impact of the type of maintenance anesthesia on the bleeding conditions of the surgical field and hemodynamic parameters during endoscopic ear surgery (EES), comparing totally intravenous inhalational anesthesia (TIVA) with inhalational anesthesia (IA). Study Design: Retrospective case-control study. Setting: Tertiary referral center. Patients: Fifteen consecutive EES cases performed with TIVA between 2019 and 2020 at our Institution were matched to a control group of patients who underwent EES with IA in the same period. Patients with American Society of Anesthesiologists IV grade, acute otitis before surgery, congenital or acquired coagulopathies, use of anti-inflammatory drugs, or antiaggregant or anticoagulant therapy in the 5 days before the intervention were excluded. Interventions: Both primary and revision tympanoplasty and stapes surgery were considered. Main Outcome Measures: Surgical videos were reviewed to quantify the entity of bleeding according to the Modena Bleeding Score. Hemodynamic parameters during surgery were retrospectively collected. A comparison between the two groups was performed. Results: No statistically significant differences between the two groups in terms of bleeding were found at any of time point evaluated. The tympanomeatal flap elevation resulted in the bloodiest step in both groups. Hemodynamic parameters were similar in both groups ( p > 0.05). Conclusions: These preliminary data do not support a significant difference in bleeding conditions and hemodynamic parameters between EES patients receiving TIVA and those receiving IA. Further studies involving a higher number of patients will improve our understanding on how maintenance anesthesia with TIVA may be beneficial in terms of bleeding control as compared with IA for patients undergoing EES.

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“…In previous studies, TIVA provided a better quality of recovery than balanced anesthesia using inhalant anesthetics and opioids [ 6 , 12 , 13 ]. Remimazolam has some benefits over propofol [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia: a randomized control trial

et al. 2022

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Background Remimazolam is a novel intravenous benzodiazepine that is appropriate for the maintenance of anesthesia. Quality of recovery is an important component of health care quality, but there is no published randomized control trial focused on the quality of recovery in patients undergoing total intravenous anesthesia with remimazolam. Methods This parallel-group, single-blind randomized control trial at a tertiary care medical center in South Korea was conducted to determine the difference in the quality of recovery between the patients administered remimazolam and those administered an inhalant anesthetic agent. A total of 168 patients aged 19–65 years who underwent elective laparoscopic cholecystectomy or robotic gynecologic surgery were considered for enrollment. Randomization was performed using sealed envelopes containing computer-generated random allocation sequences. Remimazolam was administered for the maintenance of anesthesia in the remimazolam group (Group R), and desflurane was administered in the desflurane group (Group D). The induction protocol and the target value of the bispectral index were identical in both groups. Patients were blinded to the drug that was administered until they finished the postoperative questionnaire. The main outcome measure was the decrement of the QoR-40 score on postoperative day 1 compared to the QoR-40 score on the day before surgery. Results A total of 165 patients were analyzed. The preoperative and postoperative global QoR-40 scores were 183 and 152 (IQR 173–192 and 136–169), respectively. The perioperative decrement of the global QoR-40 score was 29.96 ± 22.49. The decrement of the QoR-40 score was smaller in Group R than in Group D (26.99 versus 32.90, respectively; mean difference 5.91, 95% confidence interval -0.96–12.79). After adjustment for sex, the type of surgery and surgical time, the administration of remimazolam resulted in a 7.03-point (95% CI 0.35–13.72) less decrement of the QoR-40 score than desflurane. There were no severe adverse events in either group. Conclusion Total intravenous anesthesia maintained with remimazolam provides a better quality of recovery than anesthesia maintained with an inhalant agent in patients undergoing laparoscopic surgery. Additionally, postoperative nausea and vomiting were largely reduced with remimazolam. Trial registration KCT0006288, Clinical Research Information Service (CRIS), Republic of Korea Registration date: 23/06/2021

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Comparison of the effects of intravenous propofol and inhalational desflurane on the quality of early recovery after hand-assisted laparoscopic donor nephrectomy: a prospective, randomised controlled trial

Cited by 7 publications

References 45 publications

Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy

Randomized controlled trial of the effect of general anesthetics on postoperative recovery after minimally invasive nephrectomy

Effects of Total Intravenous Versus Inhalational Anesthesia on Bleeding During Endoscopic Ear Surgery: Preliminary Results From a Case-Control Study

Quality of recovery in patients administered remimazolam versus those administered an inhalant agent for the maintenance of general anesthesia: a randomized control trial

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