Journal of clinical anesthesia · 2026
Volatile versus intravenous anesthesia and postoperative neurocognition: A meta-analysis and trial-sequential analysis.
СтатьяМетаанализСравнительное исследованиеОбзорНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ikram Jibran, Ali Aizaz, Zaman Bushra, Mehmoud Basant Ahmed, Qayoom Hamad, Faizan Muhammad Aqib, Rehman Tooba, Farhan Kanza, Khudirat Mohammad, Abu-Shawer Osama, Kopac Orkun, Sessler Daniel I
Аннотация
BACKGROUND: Postoperative delirium and delayed neurocognitive recovery are common and consequential complications of anesthesia and surgery. Maintenance of general anesthesia with propofol-based intravenous drugs may reduce postoperative neurocognitive complications compared with volatile anesthesia.
METHODS: Major databases were searched through November 2025. The primary outcome was postoperative delirium within 7 postoperative days. Secondary outcomes included delayed neurocognitive recovery (formerly termed postoperative cognitive decline) and Mini-Mental State Examination scores on postoperative days 1, 3, and 7 (range 0 to 30, higher scores better, with 2 points being meaningful).
RESULTS: Across 29 trials (N = 11,896 patients), the incidence of postoperative delirium was similar with volatile and intravenous anesthesia RR: 0.94 [95% CI, 0.71 to 1.25]. Volatile anesthesia provoked delayed neurocognitive recovery RR: 1.35; 95% CI, 1.07 to 1.70), although effects were inconsistent across assessment periods. Postoperative MMSE scores were slightly lower with volatile anesthesia (mean difference: -1.4 points [95% CI, -2.2 to -0.6]), a difference we did not consider clinically meaningful. Both delayed neurocognitive recovery and Mini-Mental State Examination scores analyses displayed substantial heterogeneity. Trial sequential analysis indicated that more trials are needed for each outcome.
CONCLUSIONS: The incidence of postoperative delirium was similar with volatile and intravenous anesthesia. Volatile anesthesia provoked small, heterogeneous, and time-dependent differences in delayed neurocognitive recovery, but not of a meaningful magnitude. Current evidence suggests that intravenous anesthesia does not meaningfully improve postoperative neurocognitive outcomes; however, available information remains limited, heterogeneous, and imprecise.
METHODS: Major databases were searched through November 2025. The primary outcome was postoperative delirium within 7 postoperative days. Secondary outcomes included delayed neurocognitive recovery (formerly termed postoperative cognitive decline) and Mini-Mental State Examination scores on postoperative days 1, 3, and 7 (range 0 to 30, higher scores better, with 2 points being meaningful).
RESULTS: Across 29 trials (N = 11,896 patients), the incidence of postoperative delirium was similar with volatile and intravenous anesthesia RR: 0.94 [95% CI, 0.71 to 1.25]. Volatile anesthesia provoked delayed neurocognitive recovery RR: 1.35; 95% CI, 1.07 to 1.70), although effects were inconsistent across assessment periods. Postoperative MMSE scores were slightly lower with volatile anesthesia (mean difference: -1.4 points [95% CI, -2.2 to -0.6]), a difference we did not consider clinically meaningful. Both delayed neurocognitive recovery and Mini-Mental State Examination scores analyses displayed substantial heterogeneity. Trial sequential analysis indicated that more trials are needed for each outcome.
CONCLUSIONS: The incidence of postoperative delirium was similar with volatile and intravenous anesthesia. Volatile anesthesia provoked small, heterogeneous, and time-dependent differences in delayed neurocognitive recovery, but not of a meaningful magnitude. Current evidence suggests that intravenous anesthesia does not meaningfully improve postoperative neurocognitive outcomes; however, available information remains limited, heterogeneous, and imprecise.