Comparative Efficacy of Volatile vs. Intravenous Anesthetics on Postoperative Cognitive Dysfunction Rates in Neonates: A Statistical Meta-Analysis

Abstract

The problem of postoperative cognitive dysfunction (POCD) in neonates undergoing anesthesia is one that still remains to be a substantial concern, and there are implications of this in the long term neurodevelopment. This meta‐analysis was performed to compare the efficacy of volatile (sevoflurane) and intravenous anesthetics (propofol) in reducing the incidence of POCD in neonates. Studies published in a 15 year period (2010 to 2025) of 10 studies on over 1,200 neonates and infants in RCTs and cohort studies were reviewed systematically. The analysis showed a 50% reduction of POCD incidence for neonates treated with intravenous anesthetics, mainly propofol, compared to the ones treated with sevoflurane. The intravenous group had significantly less cognitive dysfunction, that is, the pooled odds ratio (OR) for POCD was 0.45 (95% CI: 0.30–0.72). Besides, there were always better cognitive outcomes in the intravenous group at follow up with better early cognitive function and less postoperative agitation. The results support the hypothesis that all intravenous anesthetics, but especially propofol, provide enhanced neuroprotective effects in neonates and decrease the risk of postoperative cognitive dysfunction. Importantly, these results have clinical implications that suggest that use of intravenous anesthesia is preferable to minimizing postoperative cognitive changes in the neonate. But this will need to be tested further in a long term follow up to see if these results hold and what are the potential long term neurodevelopmental consequences in children.