Comparison of outcomes between total intravenous (propofol and remifentanil) and inhalation (isoflurane) anesthesia in women undergoing abdominal myomectomy: a randomized controlled trial.

Abstract

Introduction: The study aimed to compare anesthesia maintenance using total intravenous anesthesia (TIVA) and inhalation anesthesia (IA) and investigating their effects on bleeding volume, intraoperative hemodynamic changes, and postoperative complications in women patients undergoing abdominal myomectomy.

Methods: A double-blind randomized controlled trial was conducted on patients undergoing abdominal myomectomy at a large non-university hospital in northwest Iran in 2023. A total of 60 eligible patients were randomly assigned to two groups of TIVA (n = 30) and IA (n = 30) anesthesia methods. The study groups' allocation was blinded to the anesthesiology provider and she was responsible for anesthesia and patient monitoring. The study outcomes were hemodynamic changes, bleeding during the surgery, anesthesia time, hospitalization, and postoperative complications between the study groups.

Results: There were no significant differences in surgical indications, myoma size, hemoglobin levels, or clinical and obstetric characteristics before surgery between the two study groups (p > 0.05). The average blood loss (201.8 vs. 391.0 ml; P = 0.001), postoperative hemoglobin levels (11.6 vs. 10.5; P = 0.005), anesthesia times (100.6 vs. 114.3 min; P = 0.003), and hospitalization days (2.06 vs. 2.36; P = 0.005) showed statistically significant differences between the TIVA and IA groups, respectively. Mean arterial pressure (MAP) and heart rate values were significantly higher in the IA group compared to the TIVA group (P < 0.05). No muscle stiffness, dizziness, or respiratory depression were observed after surgery in either study group. The proportion of shivering in the TIVA and IA groups was 16.7% and 43.3%, respectively, indicating a significant statistical difference (P = 0.024). The proportion of optimal surgeon performance was reported to be higher in the TIVA group compared to the IA group (P = 0.014).

Conclusion: According to the findings of this study, the use of the TIVA method compared to IA during the maintenance of general anesthesia was linked to a reduction in intraoperative bleeding and transfusion requirements, as well as increased optimal surgeon performance in patients undergoing abdominal myomectomy. Furthermore, patients in the TIVA group experienced fewer complications during and after surgery, along with a shorter hospital stay.

Trial registration: The study protocol was retrospectively registered and confirmed in the Iranian Registry of Clinical Trials under the number (IRCT20220930056059N1). Registration date: 2022-11-13. Expected recruitment start date: 2022-11-11.