Total Intravenous Anesthesia (TIVA) Versus Inhalational Anesthesia for Postoperative Recovery: A Systematic Review of Randomized controlled trails
DOI:
https://doi.org/10.71000/d1qj2q66Keywords:
Total intravenous anesthesia (TIVA); Inhalational anesthesia; Postoperative recovery; Quality of recovery; Propofol.Abstract
Background: Total intravenous anesthesia (TIVA) and inhalational anesthesia are widely used techniques for general anesthesia, but their effects on patient-perceived and conventional postoperative recovery outcomes are not uniform across surgical settings. This systematic review compared propofol-based TIVA with desflurane- or sevoflurane-based inhalational anesthesia in adult surgical patients.
Methods: A systematic review was conducted in accordance with PRISMA 2020. PubMed/MEDLINE, Embase, Scopus, the Cochrane Library, and ClinicalTrials.gov were searched from database inception to December 2021. Randomized controlled trials comparing propofol-based TIVA with desflurane- or sevoflurane-based anesthesia and reporting postoperative quality of recovery or related recovery outcomes were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using RoB 2. Because of substantial clinical and outcome heterogeneity, results were synthesized narratively rather than statistically pooled.
Results: Six randomized controlled trials were included, comprising 600 randomized participants and 555 participants in the analyzed datasets. Three trials (Lee et al., Na et al., and Joe et al.) reported significantly better global QoR-40 scores with TIVA at at least one principal postoperative assessment, whereas Moro et al., Kim et al., and Niu et al. found no statistically significant difference in global QoR-40. Selected domains, particularly physical comfort and physical independence, frequently favored TIVA. TIVA also reduced early nausea or rescue antiemetic use in some trials and lowered selected pain and inflammatory outcomes, but these effects were not consistent. In the trials reporting emergence time, propofol-based TIVA was associated with slower response or extubation than desflurane anesthesia.
Conclusion: Propofol-based TIVA may improve selected patient-centered recovery domains and early postoperative symptoms, but superiority in global postoperative recovery is not consistent across surgical populations. The certainty of the available evidence is limited by the small number of trials, heterogeneity in surgery and assessment timing, and inconsistent outcome reporting.
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Copyright (c) 2022 Dr. Kamran Ahmed, Dr. Haji Zyad Akhtar, Dr. Muhammad Yasin (Author)
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