Inhalational vs. Intravenous Anesthesia
Both inhalational and intravenous anesthesia can be used in different clinical contexts. Inhalational anesthesia is often carried out with sevoflurane and oxygen, among other options, while intravenous anesthesia is often carried out with propofol, among other options. Both have a place in anesthetic practice, and each presents with a unique set of benefits and considerations.
Inhalational anesthesia may be preferred by some patients and may also be easier to administer in those who do not respond well to IVs, such as many pediatric patients. . In addition, inhalational anesthesia has been found by some studies to be associated with better outcomes in cancer surgery compared to intravenous anesthesia.
A recent study was designed to assess the disease-free survival and overall survival in breast cancer patients who received either propofol (intravenous) anesthesia or isoflurane (inhalational) anesthesia during the operation 1. Data revealed that although two-year disease-free survival was higher in the volatile/inhalational group, no meaningful association was identified between the five-year overall survival rate and anesthesia technique.
Since patient satisfaction and agency can be potent predictors of a successful surgical outcome, one study sought to probe whether, given a choice, patients would prefer an inhaled or intravenous method of inducing anesthesia 2. They investigated adult patients presenting to an academic institution for ambulatory surgery. Out of all participating patients, 50% chose an inhaled induction, 33% of patients selected an intravenous induction, and 17% were undecided. Authors recommended that, where manpower and facilities allow for it, and in the absence of risk of regurgitation or airway difficulty, an inquiry should be made of healthy adults presenting for elective ambulatory surgery as to their preferred route for the induction of anesthesia.
Intravenous anesthesia (with propofol) also has its advantages, including a lower risk of respiratory events and better postoperative comfort.
A recent study sought to assess the effect of propofol vs sevoflurane on early postoperative sleep quality and complications of patients receiving laparoscopic surgery 3. Results demonstrated that sleep was slightly better, nausea, vomiting, and dizziness slightly less acute, and postoperative pain was slightly less intense when the operation was performed under propofol (intravenous) anesthesia as compared to sevoflurane (inhalational) anesthesia. Authors recommended that propofol be considered a better choice intraoperatively in order to enhance patients’ postoperative sleep quality, relieve postoperative pain, and improve patient well-being.
Another study sought to assess the difference in the rate of occurrence of perioperative respiratory adverse events between children receiving an intravenous induction and those receiving an inhalation induction of anesthesia 4. Data demonstrated that, after adjusting for age, sex, American Society of Anesthesiologists physical status and weight, children having received intravenous propofol were significantly less likely to experience perioperative respiratory adverse events than those who received inhalational sevoflurane. Authors warranted that, where clinically appropriate, anesthesiologists should consider using an intravenous propofol induction technique in children who are at high risk of experiencing perioperative respiratory adverse events.
Clearly, there are both benefits and risks to the use of inhalational versus intravenous anesthesia across a wide range of clinical contexts. Ultimately, it is up to the anesthetic team to cater the anesthesia regimen to each individual in order to ensure the best possible patient outcomes.
References
1. Karami, M. Y. et al. Comparison of volatile/inhalational and IV anesthesia in long-term survival of patients with breast cancer: a retrospective study. Eur. J. Med. Res. (2022). doi:10.1186/s40001-022-00911-9
2. Van Den Berg, A. A., Chitty, D. A., Jones, R. D., Sohel, M. S. & Shahen, A. Intravenous or inhaled induction of anesthesia in adults? An audit of preoperative patient preferences. Anesth. Analg. (2005). doi:10.1213/01.ANE.0000150609.82532.C5
3. Li, S., Song, B., Li, Y. & Zhu, J. Effects of intravenous anesthetics vs inhaled anesthetics on early postoperative sleep quality and complications of patients after laparoscopic surgery under general anesthesia. Nat. Sci. Sleep (2021). doi:10.2147/NSS.S300803
4. Ramgolam, A., Hall, G. L., Zhang, G., Hegarty, M. & Von Ungern-Sternberg, B. S. Inhalational versus Intravenous Induction of Anesthesia in Children with a High Risk of Perioperative Respiratory Adverse Events: A Randomized Controlled Trial. Anesthesiology (2018). doi:10.1097/ALN.0000000000002152