- In this review article, the authors compare outcomes associated with propofol based total intravenous anesthesia (TIVA) and volatile anesthetics.
- The authors focus on short term (PONV, quality of recovery, post operative pain) and long-term outcomes (cancer survival, cognitive dysfunction).
- While TIVA may have some advantages such as a reduced rate of PONV, the data on other postoperative outcomes remain mixed.
- Bench experiments have suggested potential analgesic effects of TIVA, however postoperative opioid consumption has not been consistently reduced.
- Quality of recovery (QoR) measurement, such as through the QoR-40 score, suggests an advantage for TIVA although evidence is mixed.
- In laboratory studies, volatile anesthetics have been shown to depress natural killer cells while TIVA potentiates their effect. However, in vivo clinical evidence is weak to recommend TIVA over volatile anesthetics in cancer treatment procedures.
- The authors note that post-operative cognitive dysfunction (POCD) is inconsistently assessed in the literature and reference a Cochrane meta-analysis showing low certainty evidence that TIVA may reduce POCD.
- In sum, the evidence of favorable outcomes associated with TIVA over volatile anesthetics remains controversial in most comparisons. Both techniques are safe and effective, and the choice of anesthetic type should be driven by clinical judgement and individualized patient analysis.
Summary of "Total Intravenous Anesthesia versus Inhalation Anesthesia for Breast Cancer Surgery: A Retrospective Cohort Study"
Summary published August 1, 2023
