• Ji-Ming Wang, Fu Xu, Gang Peng, and Sheng Lu.
• Department of Anesthesiology, Shenzhen Bao'an shajing people's hospital, Guangzhou Medical University, Shenzhen, Guangdong, China. Electronic address: jmwang1662@sina.cn.
• World Neurosurg. 2018 Nov 1; 119: e598-e606.

ObjectiveIn this study, we aimed to evaluate the efficacy and safety of sufentanil-propofol (SF) versus remifentanil-propofol (RF) as maintenance therapy for anesthesia in patients undergoing craniotomy.MethodsRandomized controlled studies on SF and RF as anesthesia for craniotomy were searched in electronic databases such as PubMed, Web of Science, Cochrane Library, Embase, CNKI, and Wanfang Data. All studies were published up to December 31, 2017. The primary outcomes were wake-up time, extubation time, and pain score. The secondary outcomes were heart rate, mean arterial pressure (MAP), and adverse reactions.ResultsIn this meta-analysis, 14 studies involving 927 patients were investigated. Compared with the SF group, RF could significantly reduce the wake-up time and extubation time after craniotomy (P = 0.02, standardized mean difference [SMD], 1.19; 95% confidence interval [CI], 0.21-2.18; P = 0.0001; SMD, 1.87; 95% CI, 0.90-2.83, respectively). Meanwhile, SF had better efficacy to alleviate postoperative pain than RF (P = 0.001; SMD, 2.10; 95% CI, -3.37 to -0.82). However, there were no obvious differences in improving heart rate and MAP between the 2 groups (P = 0.46; SMD, 0.17; 95% CI, -0.28 to 0.62; P = 0.43; SMD, 0.16; 95% CI, -0.54 to 0.23, respectively). Moreover, there were no significant differences in the incidents of nausea and vomiting, shivering, fidgeting, and respiratory depression between the SF and RF groups.ConclusionsRF as anesthesia for craniotomy had better effects in reducing the time of postoperative wake-up and extubation and significantly alleviating pain. Moreover, there were no significant differences in the incidence of adverse reactions between the 2 groups. The findings will prove beneficial for the rational use of clinical anesthetic drugs in the future.Copyright © 2018 Elsevier Inc. All rights reserved.

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