Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis
Background: The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain. Methods: A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2...
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Elsevier
2025-05-01
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| Series: | Brazilian Journal of Anesthesiology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S010400142500020X |
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| author | Gustavo R.M. Wegner Bruno F.M. Wegner Henrik G. Oliveira Luis A. Costa Luigi W. Spagnol Valentine W. Spagnol Jorge R.M. Carlotto Eugénio Pagnussatt Neto |
| author_facet | Gustavo R.M. Wegner Bruno F.M. Wegner Henrik G. Oliveira Luis A. Costa Luigi W. Spagnol Valentine W. Spagnol Jorge R.M. Carlotto Eugénio Pagnussatt Neto |
| author_sort | Gustavo R.M. Wegner |
| collection | DOAJ |
| description | Background: The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain. Methods: A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2023, adhering to the Cochrane Handbook and PRISMA guidelines. Results: Fifteen randomized controlled trials and five observational studies, comprising 1,602 patients, were included. The statistical analysis was categorized into three groups: liver transplantation (four studies), living donor hepatectomy (four studies), and liver mass hepatectomy (twelve studies). The liver mass hepatectomy group was further subdivided based on the performance of the Pringle maneuver and the use of pharmacological preconditioning. Statistically significant results are described below. In liver transplant recipients, propofol anesthesia was associated with lower AST levels on the first postoperative day. Hepatic donors anesthetized with propofol had higher total infusion volumes and intraoperative urine output. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher peak AST and ALT levels compared to those who received pharmacological preconditioning. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher AST and ALT levels on both the first and third postoperative days, increased total infusion volumes, and shorter hospital stays, when compared to pharmacological conditioning. Conclusions: Our findings do not offer sufficient evidence to inform clinical practice. The choice between propofol-based and inhalational anesthesia should be tailored to the individual patient's condition and the nature of the procedure being performed. Registration: PROSPERO ID: CRD42023460715. |
| format | Article |
| id | doaj-art-a41d4e1042224b93a098fa9035cfd7e7 |
| institution | OA Journals |
| issn | 0104-0014 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Anesthesiology |
| spelling | doaj-art-a41d4e1042224b93a098fa9035cfd7e72025-08-20T02:13:40ZengElsevierBrazilian Journal of Anesthesiology0104-00142025-05-0175384460410.1016/j.bjane.2025.844604Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysisGustavo R.M. Wegner0Bruno F.M. Wegner1Henrik G. Oliveira2Luis A. Costa3Luigi W. Spagnol4Valentine W. Spagnol5Jorge R.M. Carlotto6Eugénio Pagnussatt Neto7Universidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, BrazilUniversidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Porto Alegre, RS, BrazilUniversidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, BrazilUniversidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, BrazilUniversidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, BrazilUniversidade Federal da Fronteira Sul (UFFS), Faculdade de Medicina, Passo Fundo, RS, Brazil; Corresponding author.Universidade Federal da Fronteira Sul, Hospital de Clínicas, Departamento de Cirurgia, Passo Fundo, RS, BrazilUniversidade Federal da Fronteira Sul (UFFS), Programa de Estágio Médico em Anestesiologia, Passo Fundo, RS, BrazilBackground: The impact of choosing between inhalational anesthetics and propofol for maintenance anesthesia in liver transplantation or liver resections remains uncertain. Methods: A systematic search was conducted on PubMed, Scopus, Embase, Web of Science, and the Cochrane Library on September 5, 2023, adhering to the Cochrane Handbook and PRISMA guidelines. Results: Fifteen randomized controlled trials and five observational studies, comprising 1,602 patients, were included. The statistical analysis was categorized into three groups: liver transplantation (four studies), living donor hepatectomy (four studies), and liver mass hepatectomy (twelve studies). The liver mass hepatectomy group was further subdivided based on the performance of the Pringle maneuver and the use of pharmacological preconditioning. Statistically significant results are described below. In liver transplant recipients, propofol anesthesia was associated with lower AST levels on the first postoperative day. Hepatic donors anesthetized with propofol had higher total infusion volumes and intraoperative urine output. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher peak AST and ALT levels compared to those who received pharmacological preconditioning. Patients undergoing liver mass resection with the Pringle maneuver and propofol anesthesia had higher AST and ALT levels on both the first and third postoperative days, increased total infusion volumes, and shorter hospital stays, when compared to pharmacological conditioning. Conclusions: Our findings do not offer sufficient evidence to inform clinical practice. The choice between propofol-based and inhalational anesthesia should be tailored to the individual patient's condition and the nature of the procedure being performed. Registration: PROSPERO ID: CRD42023460715.http://www.sciencedirect.com/science/article/pii/S010400142500020XAnesthesiaHepatectomyInhalational anesthesiaLiver transplantPropofol |
| spellingShingle | Gustavo R.M. Wegner Bruno F.M. Wegner Henrik G. Oliveira Luis A. Costa Luigi W. Spagnol Valentine W. Spagnol Jorge R.M. Carlotto Eugénio Pagnussatt Neto Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis Brazilian Journal of Anesthesiology Anesthesia Hepatectomy Inhalational anesthesia Liver transplant Propofol |
| title | Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis |
| title_full | Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis |
| title_fullStr | Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis |
| title_full_unstemmed | Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis |
| title_short | Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis |
| title_sort | comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery a systematic review and meta analysis |
| topic | Anesthesia Hepatectomy Inhalational anesthesia Liver transplant Propofol |
| url | http://www.sciencedirect.com/science/article/pii/S010400142500020X |
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