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Volatile versus intravenous anesthesia and postoperative neurocognition: A meta-analysis and trial-sequential analysis
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DOI：10.1016/j.jclinane.2026.112258.png)
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Abstract
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• Across 29 trials involving nearly 12,000 patients, we found no meaningful difference in the incidence of postoperative delirium between volatile and propofol-based intravenous anesthesia, with a risk ratio of 0.94 (95% CI, 0.71–1.25) and moderate heterogeneity. • Volatile anesthesia was associated with a modestly higher risk of early delayed neurocognitive recovery (RR 1.35; 95% CI, 1.07–1.70), though effects were inconsistent across time points, marked by substantial heterogeneity, and potentially influenced by small-study bias. • Postoperative Mini-Mental State Examination scores were slightly lower with volatile agents (mean difference − 1.4 points; 95% CI, −2.2 to −0.6), but this falls below a clinically meaningful threshold and is confounded by high heterogeneity. • Trial sequential analysis for all outcomes indicates that current evidence remains underpowered, imprecise, and heterogeneous, underscoring the need for additional large, high-quality randomized trials to resolve lingering uncertainties. • Overall, our findings suggest that intravenous anesthesia does not confer substantial neurocognitive benefits over volatile agents; clinical decisions should prioritize other perioperative factors, such as patient vulnerability and optimized management, rather than anesthetic type alone.
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