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Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis

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  • Min Shui
  • Ziyi Xue
  • Xiaolei Miao
  • Changwei Wei
  • Anshi Wu

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Suggested Citation

  • Min Shui & Ziyi Xue & Xiaolei Miao & Changwei Wei & Anshi Wu, 2021. "Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis," PLOS ONE, Public Library of Science, vol. 16(7), pages 1-14, July.
    • Handle: RePEc:plo:pone00:0254271
    DOI: 10.1371/journal.pone.0254271
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    References listed on IDEAS

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    1. Xue-feng Jiao & Xue-mei Lin & Xiao-feng Ni & Hai-long Li & Chuan Zhang & Chun-song Yang & Hao-xin Song & Qiu-sha Yi & Ling-li Zhang, 2019. "Volatile anesthetics versus total intravenous anesthesia in patients undergoing coronary artery bypass grafting: An updated meta-analysis and trial sequential analysis of randomized controlled trials," PLOS ONE, Public Library of Science, vol. 14(10), pages 1-18, October.
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    Cited by:

    1. Dongho Kang & Minji Kim & Hong-Beom Bae & Seonho Moon & Joungmin Kim, 2023. "Comparison of Postoperative Recovery between Balanced and Total Intravenous Anesthesia in Patients Undergoing Off-Pump Coronary Artery Bypass (OPCAB) Surgery: A Prospective, Single-Blind Randomized St," IJERPH, MDPI, vol. 20(3), pages 1-10, January.

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