Post-Operative Effects: Comparison of Total Intravenous and Inhalational Anesthesia

Abstract

Background: Propofol is an intravenous anesthetic with known antiemetic properties. Less confirmed are its potential analgesic or antinociceptive postoperative effects when used as a maintenance anesthetic during surgery. We compared the postoperative effects of total intravenous anesthesia (TIVA) with propofol to those of inhalational anesthesia with sevoflurane and looked for differences in the quality of recovery of patients. Methods: We studied 23 patients scheduled to undergo endoscopic sinus surgery (ESS). Using a doubleblind experimental method, we randomly assigned patients to receive either TIVA with propofol/remifentanil (PR) or inhalational anesthesia with sevoflurane/remifentanil (SR). We measured degree of pain (per visual analog scale where 1=no pain and 10=worst pain imaginable), incidence of nausea and vomiting, and duration of recovery postoperatively. Results: Mean pain rating was 3.4±3.3 in the PR group and 5.3±2.8 in the SR group. Median pain rating was 3±3 in the PR group and 5.5±1.5 in the SR group. In the PR group, 3 out of 12 patients reported a pain score > 4; In the SR group, 6 out of 10 patients reported a pain score > 4. Only 1 incidence of nausea was reported per group. Narcotics administered were comparable between both groups. Mean recovery time was 67±30 minutes in the PR group and 69±27 minutes in the SR group. Conclusion: We found no statistically significant difference between TIVA with propofol and inhalational anesthesia with sevoflurane as they relate to postoperative pain, nausea and vomiting, narcotic administration, and recovery time. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial

“…There is little data comparing anesthesia complications and recovery times in TIVA and IA, with varying results for postoperative pain, nausea, and vomiting. 28,29 Evaluating differences in major complication rates including orbital injury and cerebrospinal fluid leak is difficult given the low incidence of occurrence. While it is expected that improving visual field during ESS should aid in reducing perioperative complications, the current study was not powered to detect these differences.…”

A study to compare the quality of surgical field using total intravenous anesthesia (with propofol) versus inhalational anesthesia (with isoflurane) for functional endoscopic sinus surgeries

“…However, in terms of postoperative pain, nausea and vomiting, no statistically significant difference is seen between TIVA and inhalational anesthesia. [ 18 ]…”

Effect of Intravenous Propofol and Inhaled Sevoflurane Anesthesia on Postoperative Spirometric Indices: A Randomized Controlled Trial

“…Propofol that is commonly used in total intravenous anesthesia (TIVA) has anti-oxidant and inflammatory inhibition properties (17)(18)(19). It is known that TIVA can decrease postoperative nausea and vomiting (PONV) (20) with little effects on pulmonary functions (21).…”

“…Some researchers have preferred TIVA to inhalational anesthesia for the prevention of PONV or chronic pain relief after anesthesia (20) while others found no significant differences between propofol-based TIVA and inhalational sevoflurane anesthesia in terms of postoperative pain, PONV, narcotic administration, and recovery time (17). Mensil et al in a study on ICU patients concluded that long-term sedation using inhaled sevoflurane was safer and more effective than intravenous propofol, as it significantly reduced wake-up and extubation times and increased awakening quality (26).…”