title: Total intravenous anaesthesia versus inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic surgery.
abstract: BACKGROUND
  Rapid implementation of robotic transabdominal surgery has resulted in the need for re-evaluation of the most suitable form of anaesthesia. The overall objective of anaesthesia is to minimize perioperative risk and discomfort for patients both during and after surgery. Anaesthesia for patients undergoing robotic assisted surgery is different from anaesthesia for patients undergoing open or laparoscopic surgery; new anaesthetic concerns accompany robotic assisted surgery.
  
  
  OBJECTIVE
  To assess outcomes related to the choice of total intravenous anaesthesia (TIVA) or inhalational anaesthesia for adults undergoing transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016 Issue 5), Ovid MEDLINE (1946 to May 2016), Embase via OvidSP (1982 to May 2016), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) via EBSCOhost (1982 to May 2016) and the Institute for Scientific Information (ISI) Web of Science (1956 to May 2016). We also searched the International Standard Randomized Controlled Trial Number (ISRCTN) Registry and Clinical trials gov for ongoing trials (May 2016).
  
  
  METHODS
  We searched for randomized controlled trials (RCTs) including adults, aged 18 years and older, of both genders, treated with transabdominal robotic assisted laparoscopic gynaecological, urological or gastroenterological surgery and focusing on outcomes of TIVA or inhalational anaesthesia.
  
  
  METHODS
  We used standard methodological procedures of Cochrane. Study findings were not suitable for meta-analysis.
  
  
  RESULTS
  We included three single-centre, two-arm RCTs involving 170 participants. We found one ongoing trial. All included participants were male and were undergoing radical robotic assisted laparoscopic radical prostatectomy (RALRP). The men were between 50 and 75 years of age and met criteria for American Society of Anesthesiologists physical classification scores (ASA) I, ll and III.We found evidence showing no clinically meaningful differences in postoperative pain between the two types of anaesthetics (mean difference (MD) in visual analogue scale (VAS) scores at one to six hours was -2.20 (95% confidence interval (CI) -10.62 to 6.22; P = 0.61) in a sample of 62 participants from one study. Low-quality evidence suggests that propofol reduces postoperative nausea and vomiting (PONV) over the short term (one to six hours after surgery) after RALRP compared with inhalational anaesthesia (sevoflurane, desflurane) (MD -1.70, 95% CI -2.59 to -0.81; P = 0.0002).We found low-quality evidence suggesting that propofol may prevent an increase in intraocular pressure (IOP) after pneumoperitoneum and steep Trendelenburg positioning compared with sevoflurane (MD -3.90, 95% CI -6.34 to -1.46; P = 0.002) with increased IOP from baseline to 30 minutes in steep Trendelenburg. However, it is unclear whether this surrogate outcome translates directly to clinical avoidance of ocular complications during surgery. No studies addressed the secondary outcomes of adverse effects, all-cause mortality, respiratory or circulatory complications, cognitive dysfunction, length of stay or costs. Overall the quality of evidence was low to very low, as all studies were small, single-centre trials providing unclear descriptions of methods.
  
  
  CONCLUSIONS
  It is unclear which anaesthetic technique is superior - TIVA or inhalational - for transabdominal robotic assisted surgery in urology, gynaecology and gastroenterology, as existing evidence is scarce, is of low quality and has been generated from exclusively male patients undergoing robotic radical prostatectomy.An ongoing trial, which includes participants of both genders with a focus on quality of recovery, might have an impact on future evidence related to this topic.
authors.affiliation: Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, Denmark, 2730.
authors.forename: Suzanne Forsyth
authors.initials: SF
authors.lastname: Herling
authors.affiliation: Department of Anaesthesiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, Herlev, Denmark, 2730.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Dreijer
authors.affiliation: Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev ringvej, Herlev, Denmark, 2710.
authors.forename: Gitte
authors.initials: G
authors.lastname: Wrist Lam
authors.affiliation: Department of Nursing Research, Rigshospitalet, The Abdominal Centre, Blegdamsvej 9, Copenhagen, Denmark, 2200.
authors.forename: Thordis
authors.initials: T
authors.lastname: Thomsen
authors.affiliation: The Cochrane Anaesthesia, Critical and Emergency Care Group, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej, Herlev, Denmark, 2730.
authors.forename: Ann Merete
authors.initials: AM
authors.lastname: Møller
mesh_terms: D000368:Aged; D000769:Anesthesia, Inhalation / Q000009:adverse effects; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D015742:Propofol; D011468:Prostatectomy / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D065287:Robotic Surgical Procedures / Q000379:methods*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D015742:Propofol