Comparison of TIVA and sevoflurane: ensuring hemodynamic and respiratory stability in prone position spinal surgeries: a randomized controlled trial

Background: This study evaluates the impact of total intravenous anesthesia (TIVA) versus sevoflurane anesthesia on respiratory mechanics and hemodynamic parameters during spinal surgery in the prone position. Methods: A randomized controlled trial was conducted on 52 patients (26 in the TIVA group and 26 in the sevoflurane group). Respiratory mechanics, such as peak airway pressure (Ppeak), mean airway pressure (Pmean), positive end-expiratory pressure (PEEP), end-tidal carbon dioxide (ETCO2), and dynamic compliance (Cdyn) were measured at various intervals. Hemodynamic parameters including systolic blood pressure, diastolic blood pressure, and heart rate were monitored. Results: There were no significant differences between the TIVA and sevoflurane groups in any of the measured respiratory and hemodynamic parameters. Ppeak at 30 minutes was 20 cmH2O in the TIVA group and 19 cmH2O in the sevoflurane group (p = 0.550). Mean Cdyn was 35.0 mL/cmH2O for TIVA and 34.3 mL/cmH2O for sevoflurane (p = 0.796). Both groups maintained stable hemodynamic parameters throughout surgery, with heart rate and mean arterial pressure within the normal range. Conclusions: TIVA and sevoflurane are equally effective in maintaining respiratory and hemodynamic stability during prone spinal surgeries. These findings provide flexibility for anesthesiologists in selecting the appropriate anesthesia technique based on patient and surgical factors. Clinical Trial Registration: ClinicalTrials.gov: NCT06558695. Date: 14 August 2024 Retrospectively registered.

Total intravenous anesthesia; Sevoflurane; Respiratory mechanics; Hemodynamic parameters; Spinal surgery; Prone position

[1] Kolb B, Large J, Watson S, Smurthwaite G. An innovative prone positioning system for advanced deformity and frailty in complex spine surgery. Journal of Neurosurgery: Spine. 2019; 32: 229–234.

[2] Hernandez NS, Begashaw B, Riesenburger RI, Kryzanski JT, Liu P. Spinal anesthesia in elective lumbar spinal surgery. Anesthesia and Pain Medicine. 2023; 18: 349–356.

[3] Garg B, Bansal T, Mehta N, Sharan AD. Patient positioning in spine surgery: what spine surgeons should know? Asian Spine Journal. 2023; 17: 770–781.

[4] Hasan MS, Tan JK, Chan CYW, Kwan MK, Karim FSA, Goh KJ. Comparison between effect of desflurane/remifentanil and propofol/remifentanil anesthesia on somatosensory evoked potential monitoring during scoliosis surgery: a randomized controlled trial. Journal of Orthopaedic Surgery. 2018; 26: 2309499018789529.

[5] Froese L, Gomez A, Sainbhi AS, Vakitbilir N, Marquez I, Amenta F, et al. Optimal bispectral index exists in healthy patients undergoing general anesthesia: a validation study. Journal of Clinical Monitoring and Computing. 2024; 38: 791–802.

[6] Camargo C, Abode-Iyamah K, Shah JS, Bechtle PS, Freeman WD. Comprehensive perioperative approach to complex spine deformity management. Clinical Spine Surgery. 2022; 35: 310–318.

[7] Lee R, Nader ND. Practical environmental considerations in anesthesia practice. Journal of Clinical Anesthesia. 2022; 79: 110522.

[8] Li XF, Hu JR BN, Wu Y, Chen Y, Zhang MQ, Yu H. Comparative effect of propofol and volatile anesthetics on postoperative pulmonary complications after lung resection surgery: a randomized clinical trial. Anesthesia & Analgesia. 2021; 133: 949–957.

[9] Meng W, Yang C, Wei X, Wang S, Kang F, Huang X, et al. Type of anesthesia and quality of recovery in male patients undergoing lumbar surgery: a randomized trial comparing propofol-remifentanil total i.v. anesthesia with sevoflurane anesthesia. BMC Anesthesiology. 2021; 21: 300.

[10] Negrini D, Wu A, Oba A, Harnke B, Ciancio N, Krause M, et al. Incidence of postoperative cognitive dysfunction following inhalational vs total intravenous general anesthesia: a systematic review and meta-analysis. Neuropsychiatric Disease and Treatment. 2022; 18: 1455–1467.

[11] Liu B, Huang D, Guo Y,Sun X, Chen C, Zhai X, et al. Recent advances and perspectives of postoperative neurological disorders in the elderly surgical patients. CNS Neuroscience & Therapeutics. 2022; 28: 470–483.

[12] Xing X, Qu H, Wang L, Hao X, Zhong Y, Jing F. Enhancing drug management, cost savings, and staff satisfaction in anesthesiology: a quality improvement project in a Chinese tertiary hospital. Advances in Therapy. 2024; 41: 1953–1966.

[13] Gordon DW. Environmental impact of anesthetic drugs. Current Opinion in Anesthesiology. 2024; 37: 379–383.

[14] Wilson JP III, Kumbhare D, Ronkon C, Guthikonda B, Hoang S. Application of machine learning strategies to model the effects of sevoflurane on somatosensory-evoked potentials during spine surgery. Diagnostics. 2023; 13: 3389.

[15] Taylor J, Payne T, Casey C, Kunkel D, Parker M, Rivera C, et al. Sevoflurane dose and postoperative delirium: a prospective cohort analysis. British Journal of Anaesthesia. 2023; 130: e289–e297.

[16] Mao G, Elhamdani S, Gigliotti MJ, Mace Z, Sclabassi R, Oh M, et al. Neurologic complications in monitored versus unmonitored image-guidance assisted posterior lumbar instrumentation. World Neurosurgery. 2021; 152: e155–e160.

[17] Gattinoni L, Brusatori S, D’Albo R, Maj R, Velati M, Zinnato C, et al. Prone position: how understanding and clinical application of a technique progress with time. Anesthesiology and Perioperative Science. 2023; 1: 3.

[18] Bartels K, Frendl G, Sprung J, Weingarten TN, Subramaniam B, Martinez Ruiz R, et al. Postoperative pulmonary complications with adjuvant regional anesthesia versus general anesthesia alone: a sub-analysis of the perioperative research network study. BMC Anesthesiology. 2022; 22: 136.

[19] Gunenc FS, Seyidova İ, Ozbilgin S, Ur K, Hanci V. Comparison of pressure controlled, volume controlled, and volume guaranteed pressure controlled modes in prone position in patients operated for lumbar disc herniation: a randomized trial. Medicine. 2024; 103: e37227.

[20] Peng Z, Xia J, Yin N, Xue H. The effects of volume-controlled ventilation versus pressure-controlled ventilation on hemodynamic and respiratory parameters in patients undergoing lumbar spine fusion surgery: a randomized controlled trial. Annals of Palliative Medicine. 2021; 10: 9553–9563.

[21] Lee JM, Lee SK, Kim KM, Kim YJ, Park EY. Comparison of volume-controlled ventilation mode and pressure-controlled ventilation with volume-guaranteed mode in the prone position during lumbar spine surgery. BMC anesthesiology. 2019; 19: 133.

[22] Kandasamy P, Pujari VS, Channaiah SRD. Effect of spine frame on the changes in respiratory dynamics in prone patients under general anaesthesia—a prospective, observational study. Indian Journal of Anaesthesia. 2023; 67: 609–613.

[23] Katira BH, Osada K, Engelberts D, Bastia L, Damiani LF, Li X, et al. Positive end-expiratory pressure, pleural pressure, and regional compliance during pronation: an experimental study. American Journal of Respiratory and Critical Care Medicine. 2021; 203: 1266–1274.

[24] Oğurlu M, Küçük M, Bilgin F, Sizlan A, Yanarateş O, Eksert S, et al. Pressure-controlled vs volume-controlled ventilation during laparoscopic gynecologic surgery. Journal of Minimally Invasive Gynecology. 2010; 17: 295–300.

[25] Davis R, Jewell E, Engoren M, Maile M. Difference between arterial and end-tidal carbon dioxide and adverse events after non-cardiac surgery: a historical cohort study. Canadian Journal of Anesthesia. 2022; 69: 106–118.

[26] Bang SR, Lee SE, Ahn HJ, Kim JA, Shin BS, Roe HJ, et al. Comparison of respiratory mechanics between sevoflurane and propofol-remifentanil anesthesia for laparoscopic colectomy. Korean Journal of Anesthesiology. 2014; 66: 131–135.

[27] Öztürk MC, Demiroluk Ö, Abitagaoglu S, Ari DE. The effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial. Saudi Medical Journal. 2019; 40: 1235–1241.

[28] Zhou D, Zhu X, Wang L, Yang X, Liu Y, Zhang X. Which anesthesia regimen ıs best to reduce pulmonary complications after head and neck surgery? The Laryngoscope. 2021; 131: E108–E115.

[29] Sharma S, BhalotraAR, Awal S. Changes in lung function parameters after total ıntravenous anaesthesia and balanced anaesthesia with desflurane: a prospective randomised study. Turkish Journal of Anaesthesiology and Reanimation. 2020; 48: 17–23.