This is the clinician view. It keeps every sentence of the plain guide and adds, for each section, the study design and citations of its sources. Every added sentence is cited and checked like the rest. Back to plain language.
What are the two approaches?
General anesthesia can be kept going with a gas breathed in, such as sevoflurane, or with medicines given through a vein, mainly propofol. The second approach is called total intravenous anesthesia, or TIVA.Official text3,4
The evidence in this section (2 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 3 AbbVie Inc., 2025 | FDA label | Official text | Not tracked |
|---|
| 4 Fresenius Kabi USA, LLC, 2025 | FDA label | Official text | Not tracked |
|---|
How do they compare on safety?
A 2024 meta-analysis found postoperative deaths and organ complications similar with intravenous and inhaled anesthesia.E1Strong1
A 2025 meta-analysis of randomized trials reached the same conclusion: the two are comparably safe.E1Strong2
In heart bypass surgery, the MYRIAD trial found that a volatile (inhaled) agent did not lower deaths at 1 year compared with TIVA.E1Strong5
The evidence in this section (3 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 1 Kampman JM, EClinicalMedicine, 2024 | Meta-analysis | E1Strong | 56 (RCR 17.92) |
|---|
| 2 Daccache N, Br J Anaesth, 2025 | Meta-analysis | E1Strong | 19 (RCR 7.19) |
|---|
| 5 Landoni G, N Engl J Med, 2019 | Randomized trial | E1Strong | 197 (RCR 11.63) |
|---|
Nausea, agitation and recovery
Across 145 trials and over 23,000 patients, TIVA lowered postoperative nausea and vomiting (relative risk 0.61). It also lowered emergence delirium, the confused agitation some people have on waking, and gave higher quality-of-recovery scores.E1Strong1
The 2025 review found TIVA reduced nausea, vomiting and agitation, while inhaled anesthesia gave faster recovery and lower costs.E1Strong2
A large factorial trial found that propofol lowered the risk of nausea and vomiting by 19%, similar to each of the anti-nausea medicines tested.E1Strong6
The evidence in this section (3 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 1 Kampman JM, EClinicalMedicine, 2024 | Meta-analysis | E1Strong | 56 (RCR 17.92) |
|---|
| 2 Daccache N, Br J Anaesth, 2025 | Meta-analysis | E1Strong | 19 (RCR 7.19) |
|---|
| 6 Apfel CC, N Engl J Med, 2004 | Randomized trial | E1Strong | 1,026 (RCR 37.63) |
|---|
Other points that can shape the choice
Volatile anesthetic gases, including sevoflurane, can trigger malignant hyperthermia in people who are susceptible.Official text3
The propofol label lists a history of anaphylaxis to eggs, egg products, soybeans or soy products among its contraindications.Official text4 More in The drugs you may hear about.
The evidence in this section (2 sources)
| Source | Design | Grade | Citations (NIH iCite) |
|---|
| 3 AbbVie Inc., 2025 | FDA label | Official text | Not tracked |
|---|
| 4 Fresenius Kabi USA, LLC, 2025 | FDA label | Official text | Not tracked |
|---|
What is not known yet
The reviews weigh different outcomes differently: one stresses TIVA's better recovery quality, the other inhaled anesthesia's faster recovery.E1Strong1,2
Questions you might bring to your anesthesia team
- Will my anesthesia be maintained with a gas, with TIVA, or with a mix?
- Given my history of nausea after anesthesia, what is the plan to prevent it?
- Is there anything in my history (such as malignant hyperthermia in the family, or egg or soy anaphylaxis) that changes the choice?
Every claim in this guide was written from its sources and checked against them word for word. Its clinical review by Dr. Recio, a practicing nurse anesthesiologist (CRNA), is pending. This line changes when the review is done.
Guidelines are presented for safe practice in the use of intravenous drug infusions for general anaesthesia. When maintenance of general anaesthesia is by intravenous infusion, this is referred to as total intravenous anaesthesia.
With general anesthesia, you will be unconscious and unaware of anything that happens during your procedure.
While the anesthesia is working and you are unconscious, many of your body’s functions will slow down or need help to work effectively. A tube may be placed in your throat to help you breathe.
DIPRIVAN is an intravenous general anesthetic and sedation drug indicated for: (1) • Induction of General Anesthesia for Patients Greater than or Equal to 3 Years of Age • Maintenance of General Anesthesia for Patients Greater than or Equal to 2 Months of Age • Initiation and Maintenance of Monitored Anesthesia Care (MAC) Sedation in Adult Patients • Sedation for Adult Patients in Combination with Regional Anesthesia • Intensive Care Unit (ICU) Sedation of Intubated, Mechanically Ventilated Adult Patients
Nausea and vomiting – This very common side effect can occur within the first few hours or days after surgery and can be triggered by a number of factors, such as the medication, motion, and the type of surgery.
Emergence delirium (postoperative confusional states or agitation) has occurred in approximately 12% of patients during the recovery period, and the duration is generally a few hours. The neuropsychological manifestations vary in severity between pleasant dream-like states, vivid imagery, hallucinations, and emergence delirium.
Malignant hyperthermia is a severe reaction to particular anesthetic drugs that are often used during surgery and other invasive procedures. Specifically, this reaction occurs in response to some anesthetic gases, which are used to block the sensation of pain, either given alone or in combination with a muscle relaxant that is used to temporarily paralyze a person during a surgical procedure.
People at increased risk of this disorder are said to have malignant hyperthermia susceptibility. Affected individuals may never know they have the condition unless they have a severe reaction to anesthesia during a surgical procedure or they undergo testing (for instance, if susceptibility is suspected because a family member had a severe reaction).
Anaphylaxis is defined as a serious allergic reaction that is rapid in onset and may cause death.
