Effects of Sevoflurane and Propofol During Mechanical Ventilation: A Meta-analysis of Randomized Controlled Trials

Abstract

Purpose: To compare the inflammatory response, hemodynamic stability, and postoperative recovery of sevoflurane versus propofol after mechanical ventilation during surgery, to provide references for rational anesthesia utility in clinical practice by meta-analysis.

Design: Systematic review and meta-analysis.

Methods: Pubmed, Web of Science, Cochrane Library, Wanfang Data, China National Knowledge Infrastructure, and Chinese BioMedical Literature Database were searched by computer for trials on the anesthetic effects of sevoflurane and propofol after mechanical ventilation during surgery. A random- or fixed-effects model was applied to analyze the clinical indicators and adverse impact based on heterogeneity.

Findings: As of April 21, 2023, 912 articles were retrieved, and 36 eligible articles were finally identified after screening, covering 2,691 surgical patients for meta-analysis. The combined results exhibited that the level of tumor necrosis factor (TNF)-α in alveolar lavage was significantly different between the 2 groups (-0.94, 95% confidence interval [CI]: -1.82 to -0.05, P = .038). Compared with sevoflurane, propofol significantly increased TNF-α levels in alveolar lavage. In plasma or serum, propofol significantly increased the levels of interleukin-10 (-0.73, 95% CI: -1.36 to -0.10, P = .023) and TNF-α (-0.65, 95% CI: -1.21 to -0.09, P = .022).

Conclusions: At alveolar lavage and serum or plasma levels of inflammatory factors, the proinflammatory factor TNF-α was significantly lower in the sevoflurane group than in the propofol group. This indicates that sevoflurane has a certain role in alleviating local and systemic lung inflammation. However, more randomized controlled studies are warranted in the future to confirm whether there is a difference in hemodynamic stability and postoperative recovery of patients.

Keywords: meta-analysis; propofol; randomized controlled study; sevoflurane.