The Comparative Impacts of Volatile and Intravenous Anaesthetics on the Incidence of Postoperative Acute Kidney Injury

Abstract

Abstract Background: Acute kidney injury (AKI) is a significant concern for surgical patients under general anaesthesia. This review compares AKI incidence between volatile anaesthetics and total intravenous anaesthesia (TIVA), focusing on their impact on renal outcomes.

Methods: The review included studies on adults who underwent general anaesthesia and were diagnosed with AKI according to Kidney Disease: Improving Global Outcomes (KDIGO), Risk, Injury, Failure, Loss, and End-stage Kidney Disease (RIFLE), or Acute Kidney Injury Network (AKIN) guidelines or using kidney injury biomarkers like Kidney Injury Molecule-1 (KIM-1), Neutrophil Gelatinase-Associated Lipocalin (NGAL) or plasma cytokine levels (specifically IL-6). Studies published in the last 10 years and in English were selected, excluding case reports, meta-analyses, reviews or abstracts. Searches were conducted using PubMed, Cochrane Library and other databases. The Cochrane risk-of-bias tool 2 (ROB 2) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement were used for the bias assessment.

Results: Of the 13 studies reviewed, propofol-based TIVA showed a significantly lower AKI incidence (6.8%) than sevoflurane-based volatile anaesthesia (11.7%) (p-values 0.001 to 0.031), suggesting that propofol may offer better renal protection. However, further research is needed to confirm these findings and to explore underlying mechanisms.

Discussion: Despite these findings, propofol-based TIVA appears beneficial in reducing AKI incidence compared to sevoflurane. Limitations include variability in study designs, potential biases in AKI reporting and differences in surgical contexts. This review emphasises the need for further robust research to validate these results and enhance anaesthetic practices for better kidney outcomes.