It is unclear if anaesthesia maintenance with propofol is advantageous or beneficial over inhalational agents. This study is intended to compare the effects of propofol vs. inhalational agents in maintaining general anaesthesia on patient-relevant outcomes and patient satisfaction.

It is estimated that of the more than 300 million surgical procedures undertaken worldwide annually, the majority requires anesthesia services. Propofol and volatile anesthetic agents are the key components of modern general anesthesia and account for many beneficial outcomes in clinical anesthetic practice and in perioperative medicine .

Previous attempts have been made by systematic reviews and meta-analyses to establish particular benefits for one technique over the other with mixed or inconclusive results, but concerns were also raised which methodology is able to capture these best.

Total intravenous anesthesia

It is still not known in many domains whether or not propofol-based total intravenous anesthesia (TIVA) techniques are more advantageous to patients than volatile-based anesthesia. Often, surrogate and composite endpoints have precluded clinical application of results.

Besides, patient-reported outcome measures (PROM) are increasingly relevant to health care providers and will influence clinical choices.

We have therefore undertaken a new exhaustive and comprehensive literature review representing a full spectrum of clinical applications on essential parameters relevant to the patient outcome, in particular, the influence of choice of anesthetic technique on postoperative nausea and vomiting (PONV). Potential confounders and bias were minimized by strict adherence to Cochrane guidelines

Electronic database

Electronic database searches identified studies in PubMed™, EMBASE™ and the Cochrane™ library between 01/01/1985 and 01/08/2016. Randomized controlled trials (RCTs) of peer-reviewed journals were studied. Of 6688 studies identified, 229 RCTs were included with a total of 20,991 patients. Quality control, assessment of the risk of bias, meta-bias, meta-regression and certainty in evidence were performed according to Cochrane.

Common estimates were derived from fixed or random-effects models depending on the presence of heterogeneity. Post-operative nausea and vomiting (PONV) was the primary outcome. Post-operative pain, emergence agitation, time to recovery, hospital length of stay, post-anesthetic shivering and hemodynamic instability were considered key secondary findings.

Based on the present meta-analysis there are several advantages of anesthesia maintenance with propofol over inhalational agents. While these benefits result in increased patient satisfaction, the clinical and economic relevance of these findings still need to be addressed inadequately powered prospective clinical trials.