Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis

Abstract

BackgroundIt is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction.MethodsStudies were identified by electronic database searches in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control, assessment of risk of bias, meta-bias, meta-regression and certainty in evidence were performed according to Cochrane. Common estimates were derived from fixed or random-effects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering and haemodynamic instability were considered key secondary outcomes.ResultsThe risk for PONV was lower with propofol than with inhalational agents (relative risk (RR) 0.61 [0.53, 0.69], p < 0.00001). Additionally, pain score after extubation and time in the post-operative anaesthesia care unit (PACU) were reduced with propofol (mean difference (MD) − 0.51 [− 0.81, − 0.20], p = 0.001; MD − 2.91 min [− 5.47, − 0.35], p = 0.03). In turn, time to respiratory recovery and tracheal extubation were longer with propofol than with inhalational agents (MD 0.82 min [0.20, 1.45], p = 0.01; MD 0.70 min [0.03, 1.38], p = 0.04, respectively). Notably, patient satisfaction, as reported by the number of satisfied patients and scores, was higher with propofol (RR 1.06 [1.01, 1.10], p = 0.02; MD 0.13 [0.00, 0.26], p = 0.05). Secondary analyses supported the primary results.ConclusionsBased on the present meta-analysis there are several advantages of anaesthesia maintenance with propofol over inhalational agents. While these benefits result in an increased patient satisfaction, the clinical and economic relevance of these findings still need to be addressed in adequately powered prospective clinical trials.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0632-3) contains supplementary material, which is available to authorized users.

General anesthesia technique and perception of quality of postoperative recovery in women undergoing cholecystectomy: A randomized, double-blinded clinical trial

“…A meta-analysis also related better perception of the quality of postoperative recovery in the TIVA group, which was attributed to lower frequency of PONV, agitation, and postoperative pain [6]. However, the methodological heterogeneity of the studies may explain the difference between the results obtained in that meta-analysis and our study.…”

“…The two most commonly used general anesthesia techniques are total intravenous anesthesia (TIVA) and balanced general anesthesia (BGA), with intravenous anesthesia combined with inhalation anesthesia [5]. The use of TIVA has increased recently; this technique has been reported to provide a better experience and higher levels of patient satisfaction in outpatient and inpatient surgeries, possibly because of a lower incidence of pain, agitation, and postoperative nausea and vomiting (PONV) [6]. Studies on the quality of postanesthetic and postoperative recovery have mainly focused on measures such as recovery time, cardiorespiratory complications, pain, PONV, hospital length of stay, and other complications [7].…”

General anesthesia during atrial fibrillation ablation: Standardized protocol and experience

“…A large meta‐analysis revealed a significant and clinically relevant 39% reduction in postoperative nausea and vomiting with the use of propofol over inhaled anesthetic agents 15 . Propofol was also associated with lower postoperative pain scores and requirement for analgesia, which are important determinants of patient dissatisfaction 16 .…”

Utilization of Pleth Index in Hysteroscopic Surgery: A Randomized Controlled Trial

“…Sevo urane is a commonly used volatile anesthetic that exhibits rapid pharmacokinetic properties. Schraag et al [20] reported that the time to respiratory recovery and tracheal extubation were shorter with sevo urane than with propofol. Moreover, SPI-guided analgesia has been demonstrated to be effective during general anesthesia with volatile anesthetics (e.g.…”