Sevoflurane versus propofol for anesthetic induction: A meta-analysis

We performed this meta-analysis to compare the characteristics of sevoflurane and propofol for the induction of routine anesthesia and for laryngeal mask airway (LMA) insertion. The variables assessed were 1) time to loss of consciousness, 2) incidence of apnea during induction, 3) induction complications, 4) time for successful LMA insertion, 5) success with LMA insertion on first attempt, 6) patient dissatisfaction, and 7) postoperative nausea and vomiting. MEDLINE, Embase, and the Cochrane library databases between January 1992 and October 1999 were reviewed for randomized, controlled trials comparing anesthetic induction between sevoflurane/nitrous oxide and propofol. Data from the 12 randomized, controlled studies were used for the meta-analysis. Sevoflurane induction was associated with a trend toward higher patient dissatisfaction and higher first-time success with LMA. Apnea was less common in the sevoflurane group. The incidence of postoperative nausea and vomiting was significantly more frequent in the sevoflurane group (P < 0.05). This effect was still present when all other variables, except the induction methods, were controlled. The other pooled variables did not show a significant difference between sevoflurane and propofol. Sevoflurane and propofol had similar efficacy for anesthetic induction. However, for routine outpatient surgery, propofol may still be the preferred induction anesthetic because of its favorable induction of anesthesia characteristics, high patient satisfaction, and less frequent incidence of postoperative nausea and vomiting.