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....
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2025-08-01
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| Series: | Indian Journal of Anaesthesia |
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| Online Access: | https://journals.lww.com/10.4103/ija.ija_189_25 |
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| author | Patcharin Intarakhao Peeraphong Thiarawat Teerapon Dhippayom |
| author_facet | Patcharin Intarakhao Peeraphong Thiarawat Teerapon Dhippayom |
| author_sort | Patcharin Intarakhao |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-1ac24a19cf4e4a108fd8e0ec51811bfd |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-1ac24a19cf4e4a108fd8e0ec51811bfd2025-08-21T11:15:00ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-08-0169877077810.4103/ija.ija_189_25Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysisPatcharin IntarakhaoPeeraphong ThiarawatTeerapon DhippayomBackground 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.https://journals.lww.com/10.4103/ija.ija_189_25brain relaxationcraniotomyinhalation anaesthesiaintravenous anaesthesianeurosurgerypropofol |
| spellingShingle | Patcharin Intarakhao Peeraphong Thiarawat Teerapon Dhippayom Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis Indian Journal of Anaesthesia brain relaxation craniotomy inhalation anaesthesia intravenous anaesthesia neurosurgery propofol |
| title | Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis |
| title_full | Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis |
| title_fullStr | Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis |
| title_full_unstemmed | Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis |
| title_short | Comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery: A systematic review and network meta-analysis |
| title_sort | comparison of propofol and inhalational anaesthetics for brain relaxation in neurosurgery a systematic review and network meta analysis |
| topic | brain relaxation craniotomy inhalation anaesthesia intravenous anaesthesia neurosurgery propofol |
| url | https://journals.lww.com/10.4103/ija.ija_189_25 |
| work_keys_str_mv | AT patcharinintarakhao comparisonofpropofolandinhalationalanaestheticsforbrainrelaxationinneurosurgeryasystematicreviewandnetworkmetaanalysis AT peeraphongthiarawat comparisonofpropofolandinhalationalanaestheticsforbrainrelaxationinneurosurgeryasystematicreviewandnetworkmetaanalysis AT teerapondhippayom comparisonofpropofolandinhalationalanaestheticsforbrainrelaxationinneurosurgeryasystematicreviewandnetworkmetaanalysis |