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Meta-Analysis
. 2021 Feb 15;21(1):52.
doi: 10.1186/s12871-021-01273-1.

Does a combined intravenous-volatile anesthesia offer advantages compared to an intravenous or volatile anesthesia alone: a systematic review and meta-analysis

Alexander Wolf  1   2 , Helene Selpien  3   4 , Helge Haberl  3   4 , Matthias Unterberg  3   4
Affiliations
Meta-Analysis

Does a combined intravenous-volatile anesthesia offer advantages compared to an intravenous or volatile anesthesia alone: a systematic review and meta-analysis

Alexander Wolf et al. BMC Anesthesiol. .

Abstract

Background: In anesthesia, additive drug interactions are used for reducing dose and dose-dependent side-effects. The combination of propofol with volatile anesthetics is rather unusual but might have advantages compared to the single use regarding PONV, time to extubation, movement during surgery and postoperative pain perception.

Methods: We searched PubMed, Scopus, Web of Science, and CENTRAL for relevant studies comparing combined intravenous volatile anesthesia with total intravenous or balanced anesthesia. The studies identified were summarized in a meta-analysis with the standardized mean difference or risk ratio as the effect size.

Results: Ten studies provided data. The risk for PONV in the recovery room was significantly reduced for a combined anesthesia compared to a balanced anesthesia (RR 0.657, CI 0.502-0.860, p-value 0.002). There was no significant difference detected either in the time to extubation or in pain perception. Movement during surgery was significantly reduced for a combined compared to a total intravenous anesthesia (RR 0.241, CI 0.135-0.428, p-value 0.000).

Conclusions: The combination of propofol and volatiles may have some advantages in the early occurrence of PONV compared to a balanced anesthesia. To sufficiently evaluate potential advantages of a combination of volatiles and propofol further high-quality trials are needed.

Trial registration: PROSPERO CRD42019126627 .

Keywords: CIVA; Combined intravenous volatile anesthesia; General anesthesia; Meta-analysis; PONV; Postoperative pain; Time to extubation.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram displaying the search and extraction process
Fig. 2
Fig. 2
PONV within 24 h
Fig. 3
Fig. 3
Time to extubation
Fig. 4
Fig. 4
Pain within 24 h post surgery
See this image and copyright information in PMC

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References

    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–560. doi: 10.1136/bmj.327.7414.557. - DOI - PMC - PubMed
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–634. doi: 10.1136/bmj.315.7109.629. - DOI - PMC - PubMed
    1. Borenstein MH, Higgins JPT, Rothstein H. Comprehensive meta-analysis version 3. 2019.
    1. Chen PN, Lu IC, Chen HM, Cheng KI, Tseng KY, Lee KT. Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy. Kaohsiung J Med Sci. 2016;32(1):32–37. doi: 10.1016/j.kjms.2015.11.006. - DOI - PMC - PubMed
    1. Chi X, Chen Y, Liao M, Cao F, Tian Y, Wang X. Comparative cost analysis of three different anesthesia methods in gynecological laparoscopic surgery. Front Med. 2012;6(3):311–316. doi: 10.1007/s11684-012-0205-7. - DOI - PubMed

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