Ramirez Maria F, Gan Tong J
Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Curr Opin Anaesthesiol. 2023 Aug 1;36(4):399-406. doi: 10.1097/ACO.0000000000001274. Epub 2023 Jun 19.
Surgical procedures that involve general anesthesia are performed with either volatile anesthetics or propofol-based total intravenous anesthesia. Both techniques are safe and provide appropriate conditions for surgery. Despite being a well established anesthetic, the use of propofol-based total intravenous anesthesia (TIVA) remains low. Possible explanations include the perceived increase risk of awareness, lack of target controlled infusion devices, increased turnover time for device set up and individual preference.
There are some scenarios where patients could potentially benefit from propofol-based TIVA rather than a volatile anesthetic (e.g. postoperative nausea and vomiting) and some other clinical scenarios where the use of propofol-based anesthesia remains controversial since the strength of the evidence remains low.
In this review we will summarize the clinical evidence comparing the effect of propofol-based TIVA and volatile anesthetic on postoperative outcomes such as postoperative nausea and vomiting, postoperative pain, quality of recovery, postoperative cognitive dysfunction and cancer outcomes.
涉及全身麻醉的外科手术可使用挥发性麻醉剂或丙泊酚全静脉麻醉。这两种技术都很安全，并为手术提供了合适的条件。尽管丙泊酚全静脉麻醉（TIVA）是一种成熟的麻醉方法，但其使用比例仍然较低。可能的原因包括意识风险增加的认知、缺乏靶控输注设备、设备设置周转时间增加以及个人偏好。
在某些情况下，患者可能从丙泊酚全静脉麻醉而非挥发性麻醉剂中获益（例如术后恶心和呕吐），而在其他一些临床情况下，丙泊酚麻醉的使用仍存在争议，因为证据的力度仍然较低。
在本综述中，我们将总结比较丙泊酚全静脉麻醉和挥发性麻醉剂对术后结局（如术后恶心和呕吐、术后疼痛、恢复质量、术后认知功能障碍和癌症结局）影响的临床证据。
