Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis.

BACKGROUND AND AIMS

The impact of anaesthetic agents on brain relaxation during neurosurgical procedures remains debatable. This study aimed to compare propofol and volatile anaesthetics during maintenance anaesthesia in achieving optimal brain relaxation in adults undergoing intracranial surgery.

METHODS

We searched PubMed, Embase, Cochrane, and EBSCO Open Dissertations databases from inception to February 2024. Randomised controlled trials (RCTs) comparing anaesthetic agents in patients over 18 years old undergoing neurosurgical procedures were included. The primary outcome was the proportion of subjects who achieved satisfactory brain relaxation, as indicated by a score of 1 on the 4-point Brain Relaxation Score (BRS). The revised Cochrane risk of bias tool was used to evaluate the quality of included studies. Risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effects model. The effects on brain relaxation were ranked using the surface under the cumulative ranking (SUCRA). We also evaluated the certainty of evidence using the Confidence in Network Meta-Analysis (CINeMA) online platform.

RESULTS

Out of 2,264 articles identified, 11 RCTs involving 1,367 participants were included. The chance of having satisfactory brain relaxation of the following anaesthetics appeared to be lower than propofol: sevoflurane (RR: 0.93; 95% CI: 0.79, 1.09), isoflurane (RR: 0.89; 95% CI: 0.60, 1.34), and desflurane (RR: 0.83; 95% CI: 0.65, 1.07), with moderate certainty of evidence. Propofol had the highest SUCRA ranking (81.4%).

CONCLUSION

Although all anaesthetic agents had similar effects, propofol showed a tendency towards better brain relaxation during neurosurgery. Further robust evidence is required to confirm the potential advantages of propofol.