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.
Highlights
It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents
Study selection The search of three databases resulted in 11,391 records, one further Randomized clinical trial (RCT) was identified by checking manually the reference list of included papers
229 RCTs were included in the qualitative synthesis and primary meta-analysis (Fig. 1)
Summary
It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. Previous attempts have been made by systematic reviews and meta-analyses to establish particular benefits for one technique over the other with mixed or inconclusive results, but concerns were raised which methodology is able to best capture these [3]. It is still not known in many domains whether or not propofol-based total intravenous anaesthesia (TIVA) techniques are more advantageous to patients than volatile-based anaesthesia. We have undertaken a new exhaustive and comprehensive literature review representing a wide spectrum of clinical applications on key parameters relevant to patient outcome, in particular the influence of choice of anaesthetic technique on post-operative nausea and vomiting (PONV) [6]. Potential confounders and bias were minimised by strict adherence to Cochrane guidelines [7]
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