Comparison of total intravenous anesthesia and inhalational anesthesia in patients undergoing liver surgery: a systematic review and meta-analysis
Comparação entre anestesia intravenosa total e anestesia inalatória em pacientes submetidos à cirurgia hepática: uma revisão sistemática e meta-análise
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
Abstract
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.
Conclusion
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.
Keywords
Resumo
Introdução
O impacto da escolha entre anestésicos inalatórios e propofol para manutenção anestésica em transplantes ou ressecções hepáticas permanece incerto.
Métodos
Foi realizada uma busca sistemática nas bases PubMed, Scopus, Embase, Web of Science e Cochrane Library em 5 de setembro de 2023, seguindo as diretrizes do Cochrane Handbook e PRISMA.
Resultados
Foram incluídos 15 ensaios clínicos randomizados e cinco estudos observacionais, totalizando 1.602 pacientes. A análise estatística foi categorizada em três grupos: transplante de fígado (quatro estudos), hepatectomia de doador vivo (quatro estudos) e hepatectomia de massa hepática (doze estudos). O grupo de hepatectomia de massa foi subdividido conforme a realização da manobra de Pringle e o uso de pré-condicionamento farmacológico. Resultados estatisticamente significativos são descritos a seguir. Em receptores de transplante hepático, a anestesia com propofol foi associada a níveis mais baixos de AST no primeiro dia pós-operatório. Doadores hepáticos anestesiados com propofol apresentaram maior volume total de infusão e débito urinário intraoperatório. Pacientes submetidos à ressecção de massa hepática com manobra de Pringle e anestesia com propofol apresentaram níveis mais altos de AST e ALT em comparação aos que receberam pré-condicionamento farmacológico. Esses mesmos pacientes também apresentaram níveis elevados de AST e ALT no primeiro e terceiro dias pós-operatórios, maiores volumes de infusão total e menor tempo de internação hospitalar.
Conclusão
Nossos achados não fornecem evidência suficiente para orientar a prática clínica. A escolha entre anestesia à base de propofol ou inalatória deve ser individualizada de acordo com a condição clínica do paciente e o tipo de procedimento realizado.
Registro PROSPERO
CRD42023460715.
Palavras-chave
Referencias
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Submitted date:
02/07/2024
Accepted date:
20/02/2025
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