Abstract

Intravenous and inhalational agents are commonly used in general anesthesia. However, it is still controversial which technique is superior for the quality of postoperative recovery. This meta-analysis aimed at comparing impact of total intravenous anesthesia (TIVA) versus inhalational maintenance of anesthesia on the quality of recovery in patients undergoing non-cardiac surgery. We systematically searched EMBASE, PubMed, and Cochrane library for randomized controlled trials (RCTs), with no language or publication status restriction. Two authors independently performed data extraction and assessed risk of bias. The outcomes were expressed as mean difference (MD) with 95% confidence interval (CI) based on a random-effect model. We performed trial sequential analysis (TSA) for total QoR-40 scores and calculated the required information size (RIS) to correct the increased type I error. A total of 156 records were identified, and 9 RCTs consisting of 922 patients were reviewed and included in the meta-analysis. It revealed a significant increase in total QoR-40 score on the day of surgery with TIVA (MD, 5.91 points; 95% CI, 2.14 to 9.68 points; P = 0.002; I2 = 0.0%). The main improvement was in four dimensions, including "physical comfort", "emotional status", "psychological support" and "physical independence". There was no significant difference between groups in total QoR-40 score (P = 0.120) or scores of each dimension on POD1. The TSA showed that the estimated required information size for total QoR-40 scores was not surpassed by recovered evidence in our meta-analysis. And the adjusted Z-curves did not cross the conventional boundary and the TSA monitoring boundary. Low-certainty evidence suggests that propofol-based TIVA may improve the QoR-40 score on the day of surgery. But more evidence is needed for a firm conclusion and clinical significance.

Highlights

  • The requirement for effectiveness and efficiency of healthcare resources prompts anesthesiologists to consider techniques that provide a fast and high quality of recovery

  • It revealed a significant increase in total Quality of Recovery-40 (QoR-40) score on the day of surgery with total intravenous anesthesia (TIVA) (MD, 5.91 points; 95% confidence interval (CI), 2.14 to 9.68 points; P = 0.002; I2 = 0.0%)

  • Low-certainty evidence suggests that propofol-based TIVA may improve the QoR-40 score on the day of surgery

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Summary

Introduction

The requirement for effectiveness and efficiency of healthcare resources prompts anesthesiologists to consider techniques that provide a fast and high quality of recovery. Research has focused on the impact of total intravenous anesthesia (TIVA) versus inhalational anesthesia maintenance on outcomes such as emergence time, perioperative hemodynamic parameters, pain scores and analgesic consumption, postoperative nausea and vomiting (PONV), length of hospital stay and other adverse events [1,2,3,4]. Intravenous and inhalational agents are commonly used in general anesthesia. It is still controversial which technique is superior for the quality of postoperative recovery. This meta-analysis aimed at comparing impact of total intravenous anesthesia (TIVA) versus inhalational maintenance of anesthesia on the quality of recovery in patients undergoing non-cardiac surgery

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