Isoflurane and Sevoflurane in the Operating Room: A Comprehensive Meta-Analysis of Efficacy and Safety
Made Suandika1, Rahmaya Nova Handayani1, Kevin Virirey Mondawitu1, M. Kabil Mubarrak, Yuniar Melissa Kisdyanti1

1Department of Anaesthesia, Faculty of Health Sciences, Harapan Bangsa University, Indonesia

Abstract

Background:
Volatile anesthetics like isoflurane and sevoflurane are commonly utilized to maintain general anesthesia. Although both agents have well-documented safety profiles, their relative effectiveness in influencing perioperative outcomes remains unclear.
Objective:
The purpose of this study was to evaluate and compare the clinical effectiveness and safety of isoflurane and sevoflurane in adult patients receiving general anesthesia, employing a non-inferiority approach.
Methods
A systematic review and meta-analysis were performed in accordance with the PRISMA 2020 guidelines. Four electronic databases were systematically searched for randomized controlled trials (RCTs) that compared isoflurane and sevoflurane in adult patients undergoing surgery. The primary outcomes assessed were 30-day mortality and intensive care unit (ICU) stay lasting 48 hours or more, while the secondary outcomes included extubation time, incidence of myocardial injury, need for hemodynamic support, and overall length of hospital stay.
Results
A total of nine randomized controlled trials involving 2,176 patients were analyzed. Isoflurane demonstrated non-inferiority to sevoflurane regarding the composite primary outcome (RR = 0.85, 95% CI: 0.67-1.09- p = 0.21). No significant differences were found between the two anesthetics in terms of extubation time, postoperative troponin levels, length of ICU or hospital stay, or vasopressor use. Both agents were linked to low 30-day mortality rates and stable intraoperative hemodynamics. These results support the clinical equivalence of isoflurane and sevoflurane across major perioperative outcomes.
Conclusion:
Isoflurane continues to be a safe and effective alternative to sevoflurane for general anesthesia and may be particularly advantageous in settings with limited resources due to its lower cost. The selection of anesthetic agents should be guided by patient-specific considerations, institutional guidelines, and available resources, rather than assumptions of pharmacologic superiority.

Keywords: Anesthesia, General Anesthesia, Isoflurane, Sevoflurane, RCT, Hemodynamics, Volatile

Topic: Pharmaceutical Sciences and Clinical Pharmacy