Propofol-based Anesthesia versus Volatile Anesthesia on Brain Relaxation in Neurosurgery: A Meta-analysis of Randomized Controlled Trials

Abstract

Background: The main objectives of neuroanesthesia are maintaining the stability of cerebral blood flow, intracranial pressure (ICP), and hemodynamics. Both intravenous and volatile anesthetics are frequently used in neuroanesthesia, yet the superior agent is still an ongoing debate. This study aimed to compare propofol-based versus volatile anesthesia on brain relaxation in patients undergoing neurosurgery. Subjects and Methods: PubMed, Cochrane, EMBASE, and ProQuest were searched using suitable keywords. Randomized controlled trials comparing propofol-based and volatile anesthesia for neurosurgery were included. The primary outcome was the brain relaxation score. Secondary outcomes were cerebral hemodynamics, intraoperative hemodynamics, recovery profiles, and postoperative complications. A meta-analysis was done to analyze the outcomes. Results: Seventeen studies (2135 patients) were included. Propofol-based group had lower ICP values (mean difference [MD]: −5.13 mmHg; 95% confidence interval [CI]: −6.95 to − 3.32; P < 0.00001); however, brain relaxation was similar within both groups. Intraoperative hemodynamics parameters were similar, aside from higher hypertension incidence in the propofol-based group. Remifentanil usage was higher with propofol-based anesthesia (MD: 1.08 μg; 95% CI: 0.72–1.44; P < 0.00001). Recovery profiles and postoperative complications were similar, with the exception of lower postoperative nausea and vomiting (PONV) incidence with propofol-based anesthesia (odds ratio = 0.59; 95% CI: 0.43–0.79; P = 0.0005). Conclusions: Propofol-based and volatile anesthesia provides comparable adequate brain relaxation in patients undergoing neurosurgery, although ICP was lower with propofol-based anesthesia. Propofol-based anesthesia significantly promoted the incidence of hypertension and reduced PONV. Other adverse events with both regimens were comparable.