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    Journal Reading: A. Syafaat Zulkarnain SP, S.Ked PEMBIMBING: Dr. Dian W, SP - An

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    This systematic review and meta-analysis compares propofol-based total intravenous anesthesia (TIVA) to volatile-based anesthesia. It analyzes studies from 1985 to 2016 on outcomes such as postoperative nausea and vomiting (PONV), time to recovery, postoperative pain, and patient satisfaction. The analysis found a 39% reduction in PONV and less postoperative pain with propofol. While volatile agents saw faster awakening, propofol decreased time in post-anesthesia care. Patient satisfaction also favored propofol. The review concludes that in key domains like PONV and analgesia, TIVA provides better patient outcomes than volatile anesthesia.

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    Journal Reading: A. Syafaat Zulkarnain SP, S.Ked PEMBIMBING: Dr. Dian W, SP - An

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    This systematic review and meta-analysis compares propofol-based total intravenous anesthesia (TIVA) to volatile-based anesthesia. It analyzes studies from 1985 to 2016 on outcomes such as postoperative nausea and vomiting (PONV), time to recovery, postoperative pain, and patient satisfaction. The analysis found a 39% reduction in PONV and less postoperative pain with propofol. While volatile agents saw faster awakening, propofol decreased time in post-anesthesia care. Patient satisfaction also favored propofol. The review concludes that in key domains like PONV and analgesia, TIVA provides better patient outcomes than volatile anesthesia.

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    This systematic review and meta-analysis compares propofol-based total intravenous anesthesia (TIVA) to volatile-based anesthesia. It analyzes studies from 1985 to 2016 on outcomes such as postoperative nausea and vomiting (PONV), time to recovery, postoperative pain, and patient satisfaction. The analysis found a 39% reduction in PONV and less postoperative pain with propofol. While volatile agents saw faster awakening, propofol decreased time in post-anesthesia care. Patient satisfaction also favored propofol. The review concludes that in key domains like PONV and analgesia, TIVA provides better patient outcomes than volatile anesthesia.

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    Download as pptx, pdf, or txt
    49 views14 pages

    Journal Reading: A. Syafaat Zulkarnain SP, S.Ked PEMBIMBING: Dr. Dian W, SP - An

    Uploaded by

    afatsp
    This systematic review and meta-analysis compares propofol-based total intravenous anesthesia (TIVA) to volatile-based anesthesia. It analyzes studies from 1985 to 2016 on outcomes such as postoperative nausea and vomiting (PONV), time to recovery, postoperative pain, and patient satisfaction. The analysis found a 39% reduction in PONV and less postoperative pain with propofol. While volatile agents saw faster awakening, propofol decreased time in post-anesthesia care. Patient satisfaction also favored propofol. The review concludes that in key domains like PONV and analgesia, TIVA provides better patient outcomes than volatile anesthesia.

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    of 14

    JOURNAL READING

    Propofol vs. Inhalational Agents to Maintain General


    Anaesthesia in Ambulatory and In- Patient Surgery: A
    Systematic Review and Meta-analysis

    Propofol vs. Agen Inhalasi untuk Pemeliharaan Anestesi


    Umum pada Operasi Rawat Jalan dan Rawat Inap:
    Sebuah Tinjauan Sistematis dan Meta Analisis

    A. SYAFAAT ZULKARNAIN SP, S.KED


    PEMBIMBING: dr. Dian W, Sp.An
    BACKGROUND
    It is estimated that more than 300 million surgical procedures undertaken worldwide annually, the
    majority requires anaesthesia services

    Propofol and volatile anaesthetic agents are the key components of modern general
    anaesthesia and account for many beneficial outcomes in clinical anaesthetic practice and in
    perioperative medicine

    It is still not known in many domains whether or not propofol-based total intravenous
    anaesthesia (TIVA) techniques are more advantageous to patients than volatile-based
    anaesthesia

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

    Study identification and


    selection • The coverage interval for the search was
    • Scientific articles in English, Italian, January 1st, 1985 to August 1st, 2016
    German, Spanish, and French reporting • We excluded studies where study design
    original data of RCTs (primary analysis) and methodology were unclear or did not
    and observational studies (secondary sufficiently describe the intervention, on
    analysis) published in peer-reviewed non-target populations (e.g. ICU
    journals sedation), or if a non-standardised
    • Searched in MEDLINE (Pubmed delivery protocol was used. Duplicates
    interface), EMBASE (Elsevier interface), and publications reporting non-reliable
    and the Cochrane Central Register of data or for which only the abstract.
    Controlled Trials (Wiley interface)
    Patient PONV as primary outcome
    outcome

    Patient-relevant outcomes were time to recovery


    (awakening/respiratory recovery/ orientation/reach
    a recovery score/follow simple instructions)

    Post-operative pain, agitation on emergence, post-


    anaesthetic shivering, hospital length of stay and
    haemodynamic instability requiring interventions.
    RESULTS
    For the primary outcome PONV, a statistically significant
    39% reduction of the relative risk was observed for
    propofol as compared to volatile agents (effect estimate
    0.61, 0.53–0.69 95%CI, p < 0.00001)
    • Among the secondary outcomes, mean differences of immediate
    recovery indicators as well as a lower consumption of muscle relaxants
    were significantly in favour of inhalational anaesthetics and associated
    with a faster respiratory recovery (0.82 min, 0.20–1.45 95%CI, p = 0.01)
    and time to tracheal extubation (0.70 min, 0.03–1.38 95%CI, p = 0.04)
    • On the contrary, the use of propofol shortened the mean time spent in
    PACU by − 2.91 min (− 5.47 to − 0.35 95%CI, p = 0.03).
    • Patients who received propofol for general anaesthesia experienced
    less pain post-operatively. Patient satisfaction, as a relevant patient-
    reported outcome measure, was significantly in favour of propofol as
    suggested by a higher number of satisfied patients as well as better sat-
    isfaction scores.
    Advantages for propofol over volatiles
    could be demonstrated throughout
    subgroups for PONV. Evidence for lower
    pain scores could be seen for propofol
    use in the overall analysis, and in the
    subgroups of laparoscopic and in-patient
    surgical procedures.
    DISCUSSIONS
    • The most important finding of this meta-analysis is a consistent and
    clinically relevant reduction on PONV when using TIVA over volatile
    maintenance of general anaesthesia.
    • Although the anti-emetic effect of propofol is widely known [14] and
    documented elsewhere, the adoption of this as a first line technique to
    minimise PONV has not been rou- tinely translated into clinical practice.
    • For instance, it is estimated that less than 20% of all general anaesthetics in
    the UK use propofol as maintenance
    • The present results re-emphasize the range of advantages of propofol over
    inhalational anaesthetics, including the lower re- quirements of
    postoperative analgesia.
    • Secondary outcome, a moderate but con- sistent effect on lower
    pain scores by intravenous anaesthe- sia compared to volatile
    anaesthetics .
    • Patients receiv ing TIVA experienced better pain control
    immediately after surgery (p = 0.001) and after 24 h (p = 0.1).
    • Recently, some evidence has emerged linking intraoperative
    propofol ex- posure with an intrinsic analgesic effect [27]
    demonstrated as reduced post-operative analgesic requirements
    [28] and the absence of hyperalgesia [29].
    • PONV and post-operative pain are significant de- terminants of
    patient dissatisfaction, whereas TIVA improves early patient well-
    being by reducing PONV and pain .
    • Some of the main and secondary outcomes were consistent in the domains
    of the subgroup analyses and in favour of pro- pofol maintenance. Others,
    like differences in immediate recovery milestones, type of surgery,
    haemodynamic in- stability were not.
    • We have to consider some limitations to our analysis and report.
    • Firstly, although large in number, the publications included in our systematic
    review and meta-analysis represent the scientific output across three
    decades. However, over 80% of the studies included data from 2001
    onwards and 40% were published between 2011 and 2016
    • Secondly, although the Cochrane tool for assessing risk of bias was
    systematically applied in the analysis, we have identified some areas of
    moderate risk of bias.
    • Another factor, influencing patient outcome is the incidence of
    post-operative agitation and delirium
    • In this context, it is noteworthy that after adding three
    observational studies (4387 patients) in the secondary analyses,
    there was a reduced risk for agitation with propofol.
    • There are indicative studies associating volatile agents with the
    development neuro-cognitive dysfunction
    CONCLUSION
    • Patient-reported outcomes after surgery is becoming increasingly relevant for
    health care providers to improve quality of care and to define key performance
    indicators in perioperative medicine.
    • We found reduced PONV and better analgesia with TIVA as compared to
    general anaesthesia with volatile anaesthetics.
    • This large systematic review and meta-analysis shows that in a relevant clinical
    domain of perioperative care TIVA provides a better patient experience
    compared to volatile anaesthesia with a high degree of confidence in the effect
    estimate .
    THANK YOU!

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