Daccache Nicolas, Wu Yichen, Jeffries Sean D, Zako Joe, Harutyunyan Robert, Pelletier Eric D, Laferrière-Langlois Pascal, Hemmerling Thomas M
Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
Department of Surgical Interventional Sciences, McGill University Health Center, Montreal, QC, Canada.
Br J Anaesth. 2025 May;134(5):1474-1485. doi: 10.1016/j.bja.2025.02.007. Epub 2025 Mar 11.
In the UK, total intravenous anaesthesia (TIVA) is used in 25% of general anaesthetics and is gaining traction because of its lower environmental impact and effectiveness in reducing postoperative nausea and vomiting (PONV). Although meta-analyses have compared TIVA and inhalational anaesthesia (IA), the optimal delivery method-manual infusion or target-controlled infusion (TCI)-remains underexplored. This review addresses this gap, leveraging the rapidly growing body of evidence to guide optimal anaesthetic practice.
We searched PubMed, Embase, Cochrane CENTRAL and Web of Science from inception to October 10, 2024. Studies comparing TIVA and IA across several patient-related and efficiency outcomes were included. Meta-analyses were performed for all outcomes. Subgroup analyses were performed to assess the contribution of different factors including a comparison of TCI with manual infusion in TIVA.
In total, 385 RCTs were included. No significant difference in ClassIntra grade 3-4 adverse events was observed between TIVA and IA (risk ratio [RR]: 1.00, 95% confidence interval [CI]: 0.88-1.12; P=0.97). Subgroup analysis also showed no significant difference for TCI (RR: 0.89, 95% CI: 0.66-1.21; P=0.46) or manual infusion (RR: 1.03, 95% CI: 0.90-1.17; P=0.70) groups. IA was favoured in recovery times and costs, whereas the incidence of PONV and agitation on emergence favoured TIVA. No statistical difference was observed in our other outcomes.
TIVA and IA are comparably safe, with TIVA reducing PONV and agitation, whereas IA offers faster recovery and lower costs. The use of TCI in TIVA might decrease postoperative cognitive dysfunction and increase recovery time, highlighting the need for a systematic review directly comparing TCI and manual infusion.
This review was registered prospectively with PROSPERO (CRD42024413368) on October 10, 2024. A single amendment to the title and order of outcomes was performed on November 21, 2024.
在英国，全静脉麻醉（TIVA）应用于25%的全身麻醉中，因其对环境影响较小且能有效降低术后恶心呕吐（PONV）而越来越受到关注。尽管荟萃分析比较了TIVA和吸入麻醉（IA），但最佳给药方式——手动输注或靶控输注（TCI）——仍未得到充分研究。本综述填补了这一空白，利用迅速增加的证据来指导最佳麻醉实践。
我们检索了从创刊至2024年10月10日的PubMed、Embase、Cochrane CENTRAL和Web of Science。纳入了比较TIVA和IA在多个与患者相关及效率结局方面的研究。对所有结局进行荟萃分析。进行亚组分析以评估不同因素的作用，包括在TIVA中比较TCI与手动输注。
共纳入385项随机对照试验（RCT）。TIVA和IA之间在3 - 4级不良事件方面未观察到显著差异（风险比[RR]：1.00，95%置信区间[CI]：0.88 - 1.12；P = 0.97）。亚组分析也显示TCI组（RR：0.89，95% CI：0.66 - 1.21；P = 0.46）或手动输注组（RR：1.03，95% CI：0.90 - 1.17；P = 0.70）无显著差异。IA在恢复时间和成本方面更具优势，而PONV和苏醒时躁动的发生率则有利于TIVA。在其他结局方面未观察到统计学差异。
TIVA和IA安全性相当，TIVA可降低PONV和躁动，而IA恢复更快且成本更低。TIVA中使用TCI可能会降低术后认知功能障碍并延长恢复时间，这凸显了直接比较TCI和手动输注进行系统综述的必要性。
本综述于2024年10月10日在PROSPERO（CRD42024413368）进行前瞻性注册。2024年11月21日对标题和结局顺序进行了一次修订。
