TIVA Versus Inhalational Anesthesia in Sleeve Gastrectomy Trial

Key Takeaways

• Total intravenous anesthesia was associated with shorter recovery time and lower postoperative nausea and vomiting than inhalational anesthesia.
• Visual analog scale pain scores were lower at 15 and 30 minutes, with no significant difference at 45 or 60 minutes.
• Length of stay and short-term adverse events were similar between groups, while subgroup analyses favored total intravenous anesthesia for recovery time in women and in patients aged 30 to 40 years.

In 70 patients undergoing laparoscopic sleeve gastrectomy, total intravenous anesthesia was associated with faster recovery than inhalational anesthesia in a randomized clinical trial report. Mean recovery time was 21.1 ± 15.2 minutes with total intravenous anesthesia and 34.6 ± 20.3 minutes with inhalational anesthesia.

The randomized clinical trial enrolled 70 patients undergoing laparoscopic sleeve gastrectomy, with 35 assigned to total intravenous anesthesia and 35 to inhalational anesthesia. Allocation used a computer-generated randomization sequence, and the study was conducted from January 2024 through June 2025 at Imam Khomeini Hospital Complex in Tehran. Primary outcomes were recovery time, hospital length of stay, and postoperative nausea and vomiting incidence. Secondary outcomes included visual analog scale pain scores at 15, 30, 45, and 60 minutes, plus adverse events including hypotension and bradycardia. The endpoints focused on immediate postoperative findings.

Postoperative nausea and vomiting occurred in 20% of the total intravenous anesthesia group and 34.5% of the inhalational group, with p<0.01. Pain scores were also lower with total intravenous anesthesia at 15 minutes, at 5.2 ± 1.8 versus 6.8 ± 1.5, and at 30 minutes, at 5.0 ± 1.7 versus 6.5 ± 1.6. Both early pain comparisons met p<0.05, while scores at 45 and 60 minutes did not differ significantly. Differences in pain scores were limited to the earliest postoperative assessments.

Hospital length of stay was similar between groups at 2.4 ± 0.7 days with total intravenous anesthesia and 2.7 ± 0.9 days with inhalational anesthesia, with p=0.15. Adverse events were similar between groups, and hypotension and bradycardia were among the monitored events. Subgroup analyses indicated shorter recovery time with total intravenous anesthesia in women and in patients aged 30 to 40 years, although detailed subgroup effect sizes were not reported. Overall, the reported differences centered on early recovery and symptoms rather than length of stay or short-term adverse events.