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

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.

Penehyclidine for prevention of postoperative nausea and vomiting following bimaxillary orthognathic surgery: a randomized, double-blind, controlled trial

“…Whereas in our patients, those who were given inhalational anesthetics actually received combined intravenous-volatile anesthesia. In a recent meta-analysis, the risk of PONV in the recovery room was significantly reduced after combined intravenous-volatile anesthesia when compared with inhalational anesthesia, and no significant difference was found when compared with total intravenous anesthesia [ 48 ]. This also explains why a high proportion of our patients were given inhalational anesthetics during propofol maintenance.…”

Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil

“…PONV is one of the most common complications and the most unpleasant aspect after thyroid surgery under general anesthesia. This complication can delay patient discharge from the hospital and increase the cost of care [15,16]. Thyroid surgery is specifically associated with a high incidence of PONV.…”

Nanotherapeutics for Alleviating Anesthesia‐Associated Complications

“…These anesthesia modalities can be employed individually or in combination based on various factors such as the type of surgery, patient conditions, and potential drug interactions. [ 22 , 23 ] Even though anesthesia‐related adverse events have declined over decades, there is still an estimated 18%–20% incidence rate of temporary or permanent damages associated with anesthesia. [ 24 ] The incidences of complications after anesthesia often present relatively large variability, which depends on several covariates, including the types of operation, anesthesia techniques and drugs, time after surgery, and patient characteristics (e.g., age, sex, race, comorbidities).…”