Comparative analysis of the safety of hypnotic component of anesthesia in robot-assisted radical prostatectomy: a review

Introduction. Robot-assisted laparoscopic radical prostatectomy (RALRP) is the most effective treatment option for localized prostate cancer. Special conditions of the surgery (Trendelenburg position and pneumoperitoneum) lead to negative physiological consequences. Objectives. Systematize current data of the effect of total intravenous anesthesia (TIVA) with propofol or inhaled anesthesia with sevoflurane or desflurane on undesirable perioperative events during RALRP in patients with prostate cancer. Materials and methods. Search of PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, International Standard Randomized Register of Controlled Trials, and ClinicalTrials.gov until February 2021. Results. The review included 7 randomized controlled trials. Undesirable perioperative events were nausea and vomiting, decreased jugular venous bulb blood oxygenation, increased optic nerve sheath diameter as a surrogate marker of high intracranial pressure, and high intraocular pressure. Conclusions. We found weak evidence that propofol-based TIVA may have safety advantages over inhaled anesthetics in the anesthesia provision of RARP.