Total intravenous anaesthesia (TIVA) with propofol is associated with several advantages regarding anaesthesia maintenance including increased patient satisfaction and lower rates of postoperative pain (POP) and postoperative nausea and vomiting (PONV), as concluded by a meta-analysis published in BMC Anesthesiology. ¹Schraag S, et al. BMC Anesthesiology 2018;DOI:10.1186/s12871-018-0632-3.

“It is estimated that of the more than 300 million surgical procedures undertaken worldwide annually, the majority requires anaesthesia services.”

PROSPERO

Despite several systematic reviews and meta-analyses trying to establish particular benefits for intravenous vs inhalation anaesthesia, the results are still largely inconclusive.

The new exhaustive and comprehensive literature review, registered as the PROSPERO trial (CRD42016039539), included 6688 randomised controlled trials in 20,991 patients from 1985 till 2016 and was conducted in strict adherence to Cochrane guidelines. The meta-analyses compared the effects of TIVA with propofol vs. volatile anaesthesia for maintaining general anaesthesia and determined patient-relevant outcomes and patient satisfaction, including the role of the anaesthetic modality and technique on the primary endpoint PONV, and secondary endpoints post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anaesthetic shivering, and haemodynamic instability.

Results

The results showed a lower risk for PONV for TIVA with propofol when compared to volatile anaesthesia (relative risk (RR)=0.61; range: 0.53 to 0.69; P< 0.00001). Moreover, propofol lowered pain scores when compared to inhalational agents after extubation and time in the post-operative anaesthesia care unit (PACU), mean difference (MD) -0.51 (range: -0.81 to -0.20; P=0.001) and MD -2.91 min (range: -5.47 to -0.35; P =0.03), both respectively. The time to respiratory recovery and tracheal extubation were longer for propofol when compared with volatile agents, MD 0.82 minutes (range: 0.20 to 1.45; P=0.01) and MD 0.70 minutes (range: 0.03 to 1.38; P=0.04), both respectively. Notably, patient reported a higher satisfaction with propofol vs inhalational agents RR=1.06 (range: 1.01 to 1.10, P=0.02) and MD=0.13 (range: 0.00 to 0.26; P=0.05). The primary results were supported by secondary analyses.