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Cited by 194Anesthesia and Sedative AgentsAnesthesia and Pain ManagementNausea and vomiting management

The DOI matches its Crossref record; 51 of the 52 references it cites were found in a registry or an index.

Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis

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Schraag, Stefan, Pradelli, Lorenzo, Alsaleh, Abdul Jabbar Omar, Bellone, Marco, Ghetti, Gianni, Chung, Tje Lin, Westphal, Martin, Rehberg, Sebastian·2018·BMC Anesthesiology
DOI 10.1186/s12871-018-0632-3PMC PMC6225663
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Abstract

BACKGROUND: It 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. METHODS: Studies 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. RESULTS: The 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. CONCLUSIONS: Based 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.

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Fig. 1 Study selection process of randomized controlled trials
Fig. 1 Study selection process of randomized controlled trialsCC BY · PubMed Central
Fig. 2 Forest plot of PONV for propofol and inhalational anaesthetics of the primary meta-analysis. Events refer to the number of patients with PONV. The risk ratio was used as effect size (PONV risk for the propofol group divided by PONV risk for the control group). Random effect models were applied to calculate a common estimate using the Mantel-Haenszel approach (Abbreviations: M-H Mantel-Haenszel approach, CI confidence interval)
Fig. 2 Forest plot of PONV for propofol and inhalational anaesthetics of the primary meta-analysis. Events refer to the number of patients with PONV. The risk ratio was used as effect size (PONV risk for the propofol group divided by PONV risk for the control group). Random effect models were applied to calculate a common estimate using the Mantel-Haenszel approach (Abbreviations: M-H Mantel-Haenszel approach, CI confidence interval)CC BY · PubMed Central
Fig. 3 Summary of the sensitivity analysis on PONV. This Forest plot shows results of 21 studies between 2012 and 2016 (RR relative risk with 95% confidence interval)
Fig. 3 Summary of the sensitivity analysis on PONV. This Forest plot shows results of 21 studies between 2012 and 2016 (RR relative risk with 95% confidence interval)CC BY · PubMed Central

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Metadata

Authors
Schraag, S., Pradelli, L., Alsaleh, A. J. O., Bellone, M., Ghetti, G., Chung, T. L., Westphal, M., & Rehberg, S.
Affiliations
  • Golden Jubilee National Hospital (GB)
  • Fresenius (Germany) (DE)
  • University Hospital Münster (DE)
  • Universitätsmedizin Greifswald (DE)
Corresponding author
Schraag, Stefan
ORCID
Venue
BMC Anesthesiology
Publisher
Springer Science and Business Media LLC
Published
2018-11-08
Volume
18
Issue
1
Pages
162-162
ISSN
1471-2253 (ISSN-L)
DOI
10.1186/s12871-018-0632-3
PMC
PMC6225663
OpenAlex
W2899852599
Cited by
194
References
52
Citations by year
2026: 25 · 2025: 23 · 2024: 29 · 2023: 21 · 2022: 25 · 2021: 38 · 2020: 25 · 2019: 8
FWCI
4.36
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Anesthesiology (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Fresenius Kabi (Not applicable)
Topics
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Pain Management
  • Health Sciences › Medicine › Surgery › Nausea and vomiting management
Keywords
propofol, inhalational anesthetics, postoperative nausea and vomiting, postoperative pain, emergence agitation, recovery time, extubation, patient satisfaction, outpatient surgery, inpatient surgery, hemodynamic instability, length of hospital stay, patient safety
MeSH terms
Ambulatory Surgical Procedures, Anesthesia, General, Hospitalization, Humans, Pain, Postoperative, Postoperative Pain, Propofol, Randomized Controlled Trials as Topic, Anesthetics, Inhalation, Anesthetics, Intravenous

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