Safety and recovery profile of patients after inhalational anaesthesia versus target-controlled or manual total intravenous anaesthesia: a systematic review and meta-analysis of randomised controlled trials.

Summary

Across 385 RCTs, TIVA and IA had comparable rates of serious intraoperative adverse events. IA shortened recovery and reduced costs, while TIVA lowered PONV and emergence agitation; subgroup analyses found similar safety whether TIVA was delivered by TCI or manual infusion. Signals suggest TCI-TIVA may reduce postoperative cognitive dysfunction but prolong recovery, warranting direct head-to-head comparisons.

Key Findings

• No difference in ClassIntra grade 3–4 adverse events between TIVA and IA (RR 1.00, 95% CI 0.88–1.12).
• IA favored for shorter recovery times and lower costs.
• TIVA favored for lower PONV and reduced emergence agitation.
• Subgroup: no safety difference between TCI-TIVA and manual TIVA; potential signal that TCI may decrease postoperative cognitive dysfunction while prolonging recovery.

Clinical Implications

Use IA when faster emergence and lower cost are prioritized; favor TIVA for PONV-sensitive patients or to reduce emergence agitation. Be cautious interpreting TCI-specific cognitive benefits pending direct TCI vs manual trials.

Limitations

• Heterogeneity in recovery metrics and costing across trials.
• Lack of direct head-to-head RCTs isolating TCI versus manual TIVA on cognitive outcomes.

Future Directions

Conduct adequately powered head-to-head RCTs of TCI versus manual TIVA focusing on postoperative cognitive outcomes, time to recovery, and environmental impact, with standardized recovery metrics.