Comparison of Propofol-Based Total Intravenous anesthetics Versus Volatile anesthetics on Postoperative Cognitive Function and Delirium After Adult Cardiac Surgery: An Updated Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.67464/n5nkvs82Keywords:
Postoperative cognitive dysfunction, Postoperative delirium, Cardiac surgery, Propofol / Total intravenous anaesthesia, Volatile anaesthesiaAbstract
Background and Objectives:
Postoperative neurocognitive disorders including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are frequent postoperative conditions related to cardiac surgery. It is uncertain whether the use of propofol-based total intravenous anaesthesia (TIVA) or volatile anaesthetics influences the occurrence of these conditions. This meta-analysis assessed the association between anaesthetic technique and postoperative neurocognitive outcomes in patients undergoing cardiac surgery.
Methods:
This systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, Google Scholar, and Cochrane Central were searched from inception to August 6, 2025. RCTs with adult patients (>18) undergoing cardiac surgery in which propofol-based TIVA was compared to volatile anaesthetics were included. Studies involving non-cardiac surgery, paediatric population, or mixed modes of anaesthetics were eliminated. Three authors independently screened and excluded studies that did not fulfil the inclusion criteria.
Results:
This meta-analysis included 15 RCTs involving 6973 patients. No significant difference was found between anaesthetic approaches in POCD (RR 0.91, 95% CI 0.58-1.42) and POD (RR 0.98, 95% CI 0.81-1.18). Cognitive performance assessed at 24 hours with the Mini-Mental State Examination showed no significant difference between the two groups. No significant differences were observed in the secondary outcomes i.e. ICU stay, hospital stay.
Conclusion:
TIVA using propofol and volatile anaesthetics have an equivalent postoperative neurocognitive and clinical outcome in adults undergoing cardiac surgery. Existing evidence does not show a clinically significant advantage of either anaesthetic approach on postoperative cognitive function.
