Comparison of TIVA and sevoflurane: ensuring hemodynamic and respiratory stability in prone position spinal surgeries: a randomized controlled trial

Background: This study evaluates the impact of total intravenous anesthesia (TIVA) versus sevoflurane anesthesia on respiratory mechanics and hemodynamic parameters during spinal surgery in the prone position. Methods: A randomized controlled trial was conducted on 52 patients (26 in the TIVA group and 26 in the sevoflurane group). Respiratory mechanics, such as peak airway pressure (Ppeak), mean airway pressure (Pmean), positive end-expiratory pressure (PEEP), end-tidal carbon dioxide (ETCO2), and dynamic compliance (Cdyn) were measured at various intervals. Hemodynamic parameters including systolic blood pressure, diastolic blood pressure, and heart rate were monitored. Results: There were no significant differences between the TIVA and sevoflurane groups in any of the measured respiratory and hemodynamic parameters. Ppeak at 30 minutes was 20 cmH2O in the TIVA group and 19 cmH2O in the sevoflurane group (p = 0.550). Mean Cdyn was 35.0 mL/cmH2O for TIVA and 34.3 mL/cmH2O for sevoflurane (p = 0.796). Both groups maintained stable hemodynamic parameters throughout surgery, with heart rate and mean arterial pressure within the normal range. Conclusions: TIVA and sevoflurane are equally effective in maintaining respiratory and hemodynamic stability during prone spinal surgeries. These findings provide flexibility for anesthesiologists in selecting the appropriate anesthesia technique based on patient and surgical factors. Clinical Trial Registration: ClinicalTrials.gov: NCT06558695. Date: 14 August 2024 Retrospectively registered.