Total Intravenous Anesthesia Versus Sevoflurane-Based Inhalation Anesthesia Within an Enhanced Recovery After Cardiac Surgery (ERACS) Protocol

OBJECTIVES: This study compared total intravenous anesthesia (TIVA) with sevoflurane-based inhalation anesthesia regarding perioperative outcomes in patients undergoing cardiac surgery within an Enhanced Recovery After Cardiac Surgery (ERACS) protocol. DESIGN: Single-center, retrospective, propensity score-matched analysis. SETTING: University-affiliated heart center. PARTICIPANTS: Adult patients (n = 2,812) undergoing elective or urgent cardiac surgery at the Heart Center Leipzig between December 2018 and July 2021 within an established ERACS program. INTERVENTIONS: Patients received either TIVA (propofol with short-acting opioids) or sevoflurane-based anesthesia according to a standardized ERACS protocol. MEASUREMENTS AND MAIN RESULTS: After propensity score matching for demographics, comorbidities, and surgical complexity, 1,816 patients were included (908 per group). Sevoflurane anesthesia was associated with a slightly shorter hospital length of stay (median 10 [8-13] v 10 [8-14] days; p = 0.015) and lower postoperative pain scores (median 2 [1-2] v 2 [1-3]; p < 0.001). TIVA was associated with earlier extubation (mean difference -4.8 minutes; p = 0.018) and greater postoperative hemodynamic stability (83.2% v 68.5%; p < 0.001). In-hospital mortality was numerically higher in the TIVA group (15 (1.7%) v 8 (0.9%); p = 0.142). CONCLUSIONS: Within a standardized ERACS protocol, TIVA and sevoflurane-based anesthesia were associated with broadly similar short-term outcomes. Although no statistically significant difference in mortality was observed, clinically relevant differences in infrequent outcomes cannot be excluded.