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Meta-Analysis
. 2025 Aug 29;104(35):e43342.
doi: 10.1097/MD.0000000000043342.

Effects of sevoflurane inhalation anesthesia versus propofol intravenous anesthesia on postoperative cognitive function in patients with malignant tumors: A meta-analysis

Yuhang Quan  1 , Mingxiong Zhang  2 , Mengqiu Zheng  3 , Min Zhao  1 , Zhiyong Lv  1 , Guangshun Liu  1
Affiliations
Meta-Analysis

Effects of sevoflurane inhalation anesthesia versus propofol intravenous anesthesia on postoperative cognitive function in patients with malignant tumors: A meta-analysis

Yuhang Quan et al. Medicine (Baltimore). .

Abstract

Background: Both propofol and sevoflurane, commonly used anesthetics, may cause brain oxygen metabolism abnormalities potentially linked to postoperative cognitive dysfunction (POCD), though their precise relationship with POCD requires further study.

Objective: To systematically evaluate sevoflurane inhalation versus propofol intravenous anesthesia effects on postoperative cognitive function in cancer patients.

Methods: We searched PubMed, EMbase, Cochrane Library, CBM, CNKI, Wanfang, VIP, and Chinese Biomedical Literature databases (from January 10, 2023) using keywords including Anaesthesia, Anesthetic Agents, Neoplasm, Cancer, Cognition, and Cognitive Function. Only human randomized controlled trials (RCTs) and prospective cohort studies were included; no language restrictions applied.

Results: 41 studies met criteria (40 RCTs, 1 cohort), involving 4342 patients (2171 sevoflurane, 2171 propofol). Meta-analysis: Overall POCD incidence showed no significant difference between groups. Subgroup analysis revealed significantly increased POCD with sevoflurane at unspecified postoperative times. No significant differences were found at 6 hours, 7 days, or 3 months. Significantly decreased POCD with sevoflurane was observed at 1 and 3 days postoperatively. Preoperative Mini-Mental State Examination (MMSE) scores showed no significant difference. Overall postoperative MMSE scores also showed no significant difference. However, MMSE scores were significantly lower in the sevoflurane group at 1, 3, 6, and 12 hours postoperatively. No significant differences were found at 1, 2, 3, 5, 7 days, or 1 month.

Conclusion subsections: Sevoflurane and propofol anesthesia may exert differing short-term, but not long-term, negative impacts on cognitive function in cancer patients. Overall, no significant difference exists in their effects on postoperative cognitive function.

Keywords: anesthesia; cognitive dysfunction; malignant tumor; meta-analysis; neuropsychological tests; postoperative cognitive complications; propofol; sevoflurane.

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Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Study selection process.
Figure 2.
Figure 2.
Incidence of POCD. POCD = postoperative cognitive dysfunction.
Figure 3.
Figure 3.
MMSE scores in preoperative patients. MMSE = Mini-Mental State Examination.
Figure 4.
Figure 4.
MMSE scores of patients 1 h after operation. MMSE = Mini-Mental State Examination.
Figure 5.
Figure 5.
MMSE scores of patients 3 h after operation. MMSE = Mini-Mental State Examination.
Figure 6.
Figure 6.
MMSE scores of patients 6 h after operation. MMSE = Mini-Mental State Examination.
Figure 7.
Figure 7.
MMSE scores in patients 12 h postoperatively. MMSE = Mini-Mental State Examination.
Figure 8.
Figure 8.
MMSE scores in patients 1 d after operation. MMSE = Mini-Mental State Examination.
Figure 9.
Figure 9.
MMSE scores in patients 2 d after operation. MMSE = Mini-Mental State Examination.
Figure 10.
Figure 10.
MMSE scores in patients 3 d after operation. MMSE = Mini-Mental State Examination.
Figure 11.
Figure 11.
MMSE scores in patients 5 d after operation. MMSE = Mini-Mental State Examination.
Figure 12.
Figure 12.
MMSE scores in patients 7 d after operation. MMSE = Mini-Mental State Examination.
Figure 13.
Figure 13.
MMSE scores in patients 3 mo after operation. MMSE = Mini-Mental State Examination.
Figure 14.
Figure 14.
Publication bias. (A–E) The funnel diagram of outcome indicators such as preoperative MMSE score, MMSE scores 6 hours, 1, 3, and 7 days postoperatively. MMSE = Mini-Mental State Examination, SMD = standardized mean difference.
See this image and copyright information in PMC

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