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TOPLINE:

A meta-analysis found no clear difference in the risk for postoperative delirium between patients who received volatile anesthesia and those who received propofol‑based intravenous (IV) anesthesia. Small and inconsistent early differences in cognition modestly favored propofol-based IV anesthesia but were unlikely to be clinically meaningful.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of randomized trials — searching multiple databases up to November 2025 — to compare neurocognitive outcomes after patients underwent surgery using volatile vs propofol-based IV anesthesia.
• The primary outcome was delirium diagnosed within 7 days after surgery.
• Secondary outcomes were delayed neurocognitive recovery within 30 days of surgery and scores measured using the Mini-Mental State Examination (MMSE) within 7 days, including outcomes at 1-3 months after surgery when these data were reported.
• Researchers evaluated the risk for bias, heterogeneity (I²) across trials, and certainty of evidence.

TAKEAWAY:

• The analysis included 29 trials, with most trials including fewer than 200 patients per group. Most trials were judged to have a low risk for bias, some trials raised concerns, and one trial was rated as having a high risk for bias.
• Researchers found no significant difference in the risk for postoperative delirium between patients who received volatile anesthesia and those who received propofol‑based IV anesthesia (11 trials; 8818 patients; I² = 55%).
• Patients who received volatile anesthesia had a 35% higher risk for delayed neurocognitive recovery than those who received propofol‑based IV anesthesia (15 trials; 2423 patients; P = .01; I² = 66%).
• Pooled MMSE scores were 1.5 points lower after volatile anesthesia than after propofol‑based IV anesthesia (11 trials; 1045 patients; I² = 98%). However, the difference was not considered clinically meaningful.

IN PRACTICE:

“The evidence does not support choosing intravenous anesthesia solely to reduce postoperative delirium or improve postoperative cognition,” the researchers reported.

SOURCE:

The study was led by Jibran Ikram, MD, of the Cleveland Clinic Foundation in Ohio, Cleveland. It was published online on June 11 in the Journal of Clinical Anesthesia.

LIMITATIONS: 

The trials had high heterogeneity owing to differences in baseline characteristics of patients, surgical features, and anesthesia. Cognitive outcomes were assessed using different tools at different timepoints after surgery.

DISCLOSURES:

The authors did not report any funding source. They declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.