Aug 2026· Journal of advanced scientific research· Vol 17, pp. 07-14· 0 citations
TL;DR
Both propofol and volatile inhalational agents have similar effects on brain relaxation during surgery, but propofol has slight benefits for ICP control, haemodynamic stability and for PONV, and desflurane has the best recovery times of the volatile agents across the current evidence network.
Abstract
Background: In neurosurgery, relaxation of the brain is a key factor in surgical exposure and outcome in the case of intracranial surgery. The theoretical advantages and disadvantages of total intravenous anaesthesia (TIVA) (propofol) and volatile inhalational agents (sevoflurane, isoflurane, desflurane) are both present and absent with the available evidence split over dozens of small, heterogeneous randomized controlled trials (RCTs). A current (2022-2026) review of the literature that compares the pros and cons of propofol and inhalational anaesthetic for brain relaxation and related peri-operative outcomes in neurosurgery, integrating the existing network of pairwise and multiple treatment meta-analytic evidence. Methods: A systematic literature search (Scopus, PubMed/MEDLINE, Cochrane Library, Embase) was performed from January 2022 to July 2026, which compared propofol to sevoflurane, isoflurane or desflurane in adult patients undergoing craniotomy or other intra-cranial neurosurgical procedures within RCTs, cohort studies and meta-analyses. Intraoperative brain relaxation score, ICP, haemodynamic stability, emergence and recovery times, postoperative nausea and vomiting (PONV), postoperative cognitive dysfunction (POCD)/delirium, biomarkers of neuronal injury and mortality/morbidity were extracted from the data. Findings were presented in a narrative synthesis and combined with previously published pairwise and network meta-analyses to create a network of treatments between propofol, sevoflurane, isoflurane and desflurane as per the general principles of the PRISMA-NMA reporting framework. Results: Sixteen primary studies and meta-analyses were included, including RCTs, retrospective and nationwide cohort studies, and systematic reviews in a number of thousands of patients. In most head to head trials and meta analyses, scores for brain relaxation were equally comparable between propofol and volatile agents. Propofol-based anaesthesia was associated with a modestly lower risk of intraoperative brain swelling (risk ratio [RR] 0.85), lower ICP (mean difference [MD] approximately −4 mmHg), less tachycardia (RR 0.54) and less PONV compared with volatile anaesthesia in pooled meta-analytic data. For recovery, desflurane was the fastest emerging/extubating of the inhalational agents but in at least one study was associated with more PONV and more tachycardia than TIVA. There was inconsistent evidence for postoperative cognitive dysfunction and delirium; a large multicentre randomised controlled trial (RCT) and a global observational cohort study produced partially opposing results. There was no significant difference in 90-day death rates among large national cohort data for patients undergoing cranial neurosurgery, although a small effect favoring TIVA was seen on similar spine-surgery data. Conclusion: Both propofol and volatile inhalational agents have similar effects on brain relaxation during surgery, but propofol has slight benefits for ICP control, haemodynamic stability and for PONV, and desflurane has the best recovery times of the volatile agents across the current evidence network. There is no clear and consistent benefit for either technique regarding long-term neurologic outcomes and death. Until the results of larger and well powered individual patient data network meta-analysis, selection of the anaesthetic should be individualised, and based on patient comorbidities, monitoring needs and institutional experience..
Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of intracranial carotid arteries and abnormal collateral network formation. Surgical revascularization is the standard treatment for stroke prevention, but the optimal intraoperative anesthetic strategy to minimize perioperative neurological complications remains controversial. This meta-analysis compares inhalational versus intravenous anesthesia for perioperative neurological outcomes in MMD patients undergoing revascularization. We systematically searched PubMed, Embase, Cochrane Library, and Web of Science from database inception to April 2026, including randomized controlled trials and high-quality observational studies comparing the two anesthesia regimens. Two investigators independently completed literature screening, data extraction, and risk of bias assessment. Random-effects models were applied to pool effect sizes. Primary outcomes included postoperative transient neurological events (TNEs), post-anesthesia care unit (PACU) delirium, and postoperative stroke. Evidence quality was graded using the GRADE system. Eleven studies (1673 patients, 2232 procedures) were included, with 6 studies constituting the core quantitative analysis set. Outcome coverage varied: 5 studies reported TNEs, 2 reported postoperative stroke, and only 1 single-center study reported PACU delirium. Pooled results showed no significant intergroup difference in TNEs (OR = 0.87, 95% CI: 0.55—1.38, P = 0.56, I² = 61%) or postoperative stroke (OR = 1.05, 95% CI: 0.50—2.17, P = 0.91, I² = 0%). Based on limited pediatric data, inhalational anesthesia may be associated with increased PACU delirium risk in children. Qualitative evidence indicated both regimens maintained stable cerebral oxygenation, while propofol-based intravenous anesthesia had advantages in reducing intracranial pressure and improving surgical field exposure. Current low-to-very-low quality evidence shows no significant difference in major perioperative neurological complications between the two anesthetic regimens for MMD revascularization. Intravenous anesthesia has potential advantages in intraoperative cerebral physiology and surgical conditions, and may be considered preferentially for children at high delirium risk, with limited evidence strength. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251272930.
Mengting Hu, Ye Ma· BMC Anesthesiology· 0 citations
BACKGROUND
Multimodal anesthesia (MMA) is widely used to reduce opioid use and improve postoperative recovery. However, evidence for bundled MMA regimens-defined as opioids plus ≥2 adjunct analgesic modalities-has not been systematically synthesized across patient-centered outcomes.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials comparing MMA (opioids plus ≥2 adjuncts, including regional techniques and/or systemic agents such as dexmedetomidine, ketamine, intravenous lidocaine, clonidine, or magnesium) with opioid-based general anesthesia in adults undergoing elective surgery. MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched to 28 October 2025. Primary outcomes were postoperative pain, PONV, QoR-15, and pulmonary complications. Secondary outcomes included opioid consumption in Morphine Milligram Equivalent (MME) and PACU length of stay. Risk of bias was assessed with RoB 2 and certainty with GRADE. Registered in PROSPERO (CRD42024470056).
RESULTS
Twenty-one RCTs (n = 1828) were included. At 24 h, no clear effect of MMA on pain intensity was observed (10 trials, n = 785; MD -0.6, 95% CI -1.5 to 0.2; very low certainty). MMA reduced PONV incidence (4 trials, n = 352; RR 0.59, 95% CI 0.44 to 0.77; low certainty). For secondary outcomes, MMA reduced opioid consumption (10 trials, n = 915; MD -7.0 mg MME, 95% CI -12.8 to -1.3; moderate certainty), with the opioid-sparing effect persisting at 48 h (MD -14.0 mg MME) and study end (MD -16.0 mg). Data for QoR-15, PACU stay, and pulmonary complications were insufficient for pooling.
CONCLUSIONS
MMA shows no clear effect on postoperative pain at 24 h but reduces PONV incidence and opioid consumption. Evidence certainty ranges from moderate to very low. Larger, standardized trials are needed to define optimal MMA regimens and patient selection.
Stefano M Arigoni, Adina B Heitmann-Frei, Marc von Gernler et al.· Journal of clinical anesthes...· 0 citations
Introduction Propofol-based total intravenous anesthesia (TIVA) with remifentanil is widely used for general anesthesia but is frequently associated with hypotension and bradycardia. Remimazolam, an ultra–short-acting benzodiazepine, provides rapid onset and offset, with the additional advantage of reversal by flumazenil, and may result in less hemodynamic depression. Previous randomized studies have largely focused on the induction phase or the incidence of hypotension, with limited data on continuous intraoperative hemodynamic changes during laparoscopic gynecologic surgery. The study is designed to compare prospectively the intraoperative hemodynamic profiles of remimazolam-based versus propofol-based TIVA in patients undergoing robotic gynecologic surgery in the Trendelenburg position. Methods and Analysis This prospective, single-center, randomized, single-blind, parallel-group superiority trial will be conducted at CHA Ilsan Medical Center, a secondary care university-affiliated hospital. In total, 58 adult patients (aged 19–65 years, American Society of Anesthesiologists physical status I–II) scheduled for elective robotic laparoscopic hysterectomy under general anesthesia will be enrolled and randomly assigned (1:1) to receive either remimazolam- or propofol-based total intravenous anesthesia, both in combination with remifentanil. Continuous invasive mean arterial pressure (MAP) will be monitored using a FloTrac™ sensor (Edwards Lifesciences, Irvine, CA, United States). The primary outcome will be the time-weighted average MAP (TWA-MAP), analyzed using analysis of covariance adjusted for baseline MAP. Secondary outcomes will include the area under the curve for hypertensive and hypotensive burden, as well as the incidence of adverse hemodynamic events, including hypotension, hypertension, bradycardia, and tachycardia. Generalized estimating equations (GEE) will be used to evaluate hemodynamic and respiratory parameters across predefined time points. Discussion This trial is expected to provide prospective, randomized evidence to compare continuous intraoperative blood-pressure trajectories between remimazolam- and propofol-based TIVA during robotic gynecologic surgery. It is anticipated that the findings will clarify the relative hemodynamic stability of these anesthetic agents under the combined physiological challenges of Trendelenburg positioning and pneumoperitoneum. The findings may inform anesthetic drug selection and intraoperative blood pressure management strategies, enhancing cardiovascular stability and improving postoperative outcomes. Clinical Trial Registration ClinicalTrials.gov, identifier NCT07251101.
Jung Min Lee, Joohyun Lee, S. Kang et al.· Frontiers in Pharmacology· 0 citations
The choice of anesthetic strategy in children undergoing craniotomy for brain tumors requires a comprehensive assessment not only of intracranial hypertension control, but also of systemic hemodynamics, tissue perfusion, volemic status, and the profile of early postoperative complications. According to contemporary reviews, particular importance in pediatric neuroanesthesiology is attached to the safe maintenance of cerebral perfusion, reduction of the risk of postoperative nausea and vomiting, and the use of noninvasive markers of intracranial pressure, including ultrasonographic measurement of the optic nerve sheath diameter (ONSD).The aim of this review-analytical study was to compare the clinical and physiological effects of propofol and sevoflurane in children with brain tumors on the basis of a statistical analysis of 99 observations. The study included 51 patients in the propofol group and 48 patients in the sevoflurane group. The analysis demonstrated that propofol was associated with more stable mean arterial pressure after intubation and at the end of surgery, lower lactate levels by the completion of the procedure, and a lower incidence of early postoperative complications. At the same time, both anesthetic techniques provided a comparable reduction in ONSD by the end of surgery, indicating equally effective control of intracranial hypertension according to this noninvasive marker.The key clinical conclusions are as follows: baseline ONSD should not be regarded as the sole criterion for anesthetic selection; propofol offers advantages when greater hemodynamic stability, a more favorable metabolic profile, and prevention of postoperative nausea and somnolence are required; sevoflurane remains clinically relevant as an option with a tendency toward faster emergence. The scientific value of the study lies in the development of clinically oriented recommendations for the choice of anesthetic agent and infusion strategy in pediatric neurosurgery.
E. Satvaldieva, A.A. Abdukadirov, B.F. Khodjiev et al.· Journal of modern medicine· 0 citations
Introduction: Agents used for induction of anaesthesia often cause vasodilation and suppression of the sympathetic nervous system, leading to a drop in blood pressure. Additionally, laryngoscopy and endotracheal intubation can cause hypertension and tachycardia. So, maintaining haemodynamic stability during induction, intubation and maintenance of anaesthesia is important. Induction of anaesthesia needs sufficient depth of anaesthesia while preventing haemodynamic derangement.
Aim: To study the haemodynamic effects of dexmedetomidine when used as an adjuvant to propofol as compared to propofol as a sole agent in the induction of General Anaesthesia (GA) in patients undergoing elective surgeries under GA.
Materials and Methods: This double-blinded randomised clinical study was conducted at the Department of Anaesthesiology, SUT Academy of Medical Sciences, Trivandrum, Kerala, India, from October 2025 to April 2026. A total of 38 patients were enrolled and randomly assigned to two groups. Group A patients were induced with propofol and vecuronium as muscle relaxants, and in Group B patients were initially given dexmedetomidine before induction with propofol and vecuronium. Heart Rate (HR), Non Invasive Blood Pressure (NIBP) Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP) and Oxygen Saturation (SpO2 ) were recorded in each group at pre op, before induction, one minute, five minutes, 10 minutes and 15 minutes post induction. An Independent t-test was used to compare quantitative parameters, Chi-square test for categorical variables and a Mann-Whitney U Test for comparing ordinal parameters.
Results: A total of 38 patients assessed showed no significant demographic differences. Post induction tachycardia (group A-91.11±5.78; group B-79.00±13.25) was significant in group A. There was significant hypotension (MAP, DBP) post induction in group A {MAP 5 min post induction (group A-84.1±11.0, group B-93.1±9.6), DBP 5 min post induction (group A-70.6±9.8; group B-77.8±10)}. Group A required a significantly higher mean dose of propofol (134.2±25.2 mg) compared to group B (101.1±18.8 mg).
Conclusion: Dexmedetomidine as an adjuvant to propofol provides better haemodynamic stability than propofol alone during induction of GA. The total propofol requirement is also significantly lower in the patients when induced along with Dexmedetomidine.
Jayakrishna Vijayakumar, Tania Jose, Rajan Babu et al.· Journal of Clinical and Diag...· 0 citations
Purpose Ciprofol provides more stable induction, though its impact on patients’ quality of recovery (QoR) and brain oxygenation requires clarification. This trial assessed whether propofol anesthesia is non-inferior to ciprofol regarding postoperative recovery quality, while additionally comparing their effects on intraoperative cerebral oxygenation. Patients and Methods This single-center, randomized, double-blind, non-inferiority study involved 94 patients scheduled for elective surgery, randomized equally to receive ciprofol (Group C) or propofol (Group P). The primary outcome was the global QoR-15 score measured 24 hours after surgery, with a non-inferiority threshold set at −6.0. Secondary outcomes included 48-hour QoR-15 scores, injection pain frequency, vasopressor requirements, and regional cerebral oxygen saturation (rScO2). Results Eighty- eight patients completed the study (Group C: 44; Group P: 44). In ITT analysis, the mean QoR-15 score at 24 hours for Group C was non-inferior to Group P (Pnon-inferiority < 0.001), with consistent findings in the PP analysis. Similar non-inferiority was observed at 48 hours. However, Group C experienced a notably lower rate of injection pain (4.5% vs 59.0%, P < 0.001) and required less phenylephrine (P = 0.009). Although Group P had higher heart rates after induction of anesthesia (P < 0.05), its average arterial pressure was notably reduced (P < 0.05). Notably, rScO2 in group C was higher than that in group P after induction of anesthesia (P = 0.046) and during the anesthesia maintenance phase (P < 0.05). Conclusion Ciprofol is non-inferior to propofol regarding early postoperative recovery quality. Furthermore, ciprofol mitigates injection pain, reduces vasoconstrictor requirements, and better maintains cerebral oxygenation.
Lideng Guo, Lianjie Cai, Botong Ni et al.· Drug Design, Development and...· 0 citations