Sevoflurane inhalation sedation could shorten the duration of endotracheal intubation and the total length of hospital stay of critical patients after surgery as compared with propofol intravenous sedation: a Meta-analysis of 537 patients

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To compare the influence of sevoflurane inhalation sedation and propofol intravenous sedation on duration of endotracheal intubation as well as the length of intensive care unit (ICU) stay and total length of hospital stay in postoperative critical patients. Six databases including CNKI, Wanfang data, PubMed, Embase, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) about the influence of sevoflurane inhalation sedation or propofol intravenous sedation on the sedation time, the duration of endotracheal intubation, the length of ICU stay, the total length of hospital stay and the adverse effects rate in postoperative critical patients from the time of database establishment to July 2018. At the same time, the reference materials of included literature were retrieved manually. All literatures were screened by three independent reviewers, and the data extraction and quality evaluation of the included studies were conducted. Meta-analysis was used for RCT that met the quality standards. A total of 7 RCT studies were enrolled involving 537 patients who were all transferred into ICU after surgery with trachea cannula. Among the patients, 272 received sevoflurane sedation while the other 265 received propofol sedation. All the included studies were well designed and of high quality. The results of Meta-analysis showed that compared with propofol sedation, sevoflurane sedation could significantly shorten the duration of endotracheal intubation [standardized mean difference (SMD) = -0.60, 95% confidence interval (95%CI) = -0.88 to -0.31, P < 0.000 1] and the total length of hospital stay (SMD = -0.36, 95%CI = -0.61 to -0.12, P = 0.003), and lower the cardiac troponin T (cTnT) within 12-24 hours after ICU admission (SMD = -0.61, 95%CI = -0.85 to -0.36, P < 0.000 01). There was no significant difference in the sedation time (SMD = -0.07, 95%CI = -0.29 to 0.15, P = 0.52), the length of ICU stay (SMD = -0.19, 95%CI = -0.39 to 0.01, P = 0.06), the incidence of nausea and vomiting [odds ratio (OR) = 1.19, 95%CI = 0.61 to 2.32, P = 0.61] or incidence of delirium (OR = 0.80, 95%CI = 0.34 to 1.90, P = 0.62) between sevoflurane group and propofol group. Sevoflurane inhalation sedation may lead to shorter duration of endotracheal intubation and total length of hospital stay, and had better protection for myocardium as compared with propofol intravenous sedation. The above conclusions needed further study to confirm, due to the lack of literature enrolled in this Meta-analysis.