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Related Concept Videos

Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
General Anesthesia: Overview01:24

General Anesthesia: Overview

Anesthesia is a medical procedure that uses drugs for CNS suppression to enable painless surgeries and procedures. The selection of anesthetics is influenced by their pharmacokinetic properties, side effects, and patient characteristics. Various types of anesthesia include general, local, regional, spinal, and inhalational.
General anesthesia induces unconsciousness in the whole body, while the others target specific areas or sensations. It is administered to minimize adverse effects, maintain...
Inhalational Anesthetics: Overview01:20

Inhalational Anesthetics: Overview

Inhalation anesthetics are drugs that induce general anesthesia upon inhalation. They work by increasing the sensitivity of GABAA receptors or inhibiting NMDA receptors, leading to a decrease in central nervous system activity. The depth of anesthesia can be rapidly adjusted by changing the concentration of the inhaled gas. Some common examples of inhalational anesthetics include volatile liquids like isoflurane, desflurane, sevoflurane and gases like xenon and nitrous oxide. Isoflurane, a...
Stages of General Anesthesia01:22

Stages of General Anesthesia

Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
One of the advantages of...
Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...

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Feasibility of a Postanesthesia Care Unit-Based Enhanced Recovery Pathway after Elective Hemiarch Replacement with Circulatory Arrest.

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In Vitro Method to Control Concentrations of Halogenated Gases in Cultured Alveolar Epithelial Cells
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Published on: October 23, 2018

Total Intravenous Anesthesia Versus Sevoflurane-Based Inhalation Anesthesia Within an Enhanced Recovery After Cardiac

Adam Fazekas1, Anna Flo Forner2, Anita Brondani2

  • 1Department of Anesthesiology and Intensive Care Medicine, Dietrich-Bonhoeffer-Klinikum, Neubrandenburg, Germany.

Journal of Cardiothoracic and Vascular Anesthesia
|June 25, 2026
PubMed
Summary

This study found total intravenous anesthesia (TIVA) and sevoflurane anesthesia offer similar perioperative outcomes in cardiac surgery patients within an Enhanced Recovery After Cardiac Surgery (ERACS) protocol. While TIVA showed earlier extubation and better hemodynamic stability, sevoflurane had shorter hospital stays and less pain.

Keywords:
Enhanced Recovery After Cardiac Surgery (ERACS)cardiac anesthesiacardiopulmonary bypasssevoflurane: fast-track cardiac surgerytotal intravenous anesthesia (TIVA)

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Area of Science:

  • Anesthesiology
  • Cardiac Surgery
  • Perioperative Medicine

Background:

  • Enhanced Recovery After Cardiac Surgery (ERACS) protocols aim to optimize patient outcomes.
  • Anesthesia choice, including total intravenous anesthesia (TIVA) and sevoflurane-based inhalation anesthesia, can influence perioperative recovery.
  • Comparing these anesthetic techniques within an ERACS framework is crucial for refining surgical protocols.

Purpose of the Study:

  • To compare perioperative outcomes between TIVA and sevoflurane-based anesthesia in adult patients undergoing cardiac surgery.
  • To evaluate the efficacy of TIVA versus sevoflurane within a standardized ERACS protocol.
  • To identify potential differences in recovery metrics, pain, and hemodynamic stability.

Main Methods:

  • A single-center, retrospective, propensity score-matched analysis was conducted.
  • Adult patients (n=2,812) undergoing elective or urgent cardiac surgery within an ERACS program were included.
  • 1,816 patients (908 per group) were matched to compare TIVA (propofol/opioids) with sevoflurane-based anesthesia.

Main Results:

  • Sevoflurane anesthesia was linked to a shorter hospital stay (p=0.015) and lower postoperative pain scores (p<0.001).
  • TIVA was associated with earlier extubation (mean difference -4.8 min; p=0.018) and improved postoperative hemodynamic stability (83.2% vs 68.5%; p<0.001).
  • In-hospital mortality was numerically higher in the TIVA group (1.7% vs 0.9%), though not statistically significant (p=0.142).

Conclusions:

  • Both TIVA and sevoflurane anesthesia demonstrate broadly similar short-term outcomes within an ERACS protocol for cardiac surgery.
  • While specific advantages exist for each technique (e.g., TIVA for hemodynamics, sevoflurane for pain/LOS), overall differences are minimal.
  • Clinically relevant differences in infrequent outcomes, including mortality, cannot be definitively excluded despite no statistical significance.