A Randomized Controlled Study Comparing the Hemodynamic Stability, Recovery Profile, and Patient Satisfaction between Total Intravenous Anesthesia and Balanced General Anesthesia in Elective Laparoscopic Procedures

Abstract

Background: Laparoscopic surgery is increasingly performed because of its advantages of reduced postoperative pain, shorter hospital stay, and faster recovery. However, the physiological effects of pneumoperitoneum may lead to significant hemodynamic changes during surgery. Total Intravenous Anaesthesia (TIVA) has been suggested to provide improved hemodynamic stability and faster recovery compared with Balanced General Anaesthesia (BGA). This study was undertaken to compare the hemodynamic stability, recovery profile, and patient satisfaction between TIVA and BGA in elective laparoscopic procedures. Aim: To compare the hemodynamic stability, recovery profile, and patient satisfaction between Total Intravenous Anaesthesia and Balanced General Anaesthesia in adult patients undergoing elective laparoscopic surgery. Materials and Methods: This prospective, randomised, controlled, double-blind comparative study was conducted in the Department of Anaesthesiology at CSI Redfern Mission Hospital, Hassan, Karnataka, India, from June 2024 to May 2026. A total of 95 adult patients (ASA physical status I–II) undergoing elective laparoscopic procedures were randomly allocated into Group T (TIVA, n=48) and Group B (Balanced General Anaesthesia, n=47). Hemodynamic parameters including heart rate and mean arterial pressure were recorded at predefined intraoperative intervals. Recovery profile was assessed by time to spontaneous respiration, eye opening, extubation, response to verbal commands, orientation, Modified Aldrete Recovery Score, and duration of post-anaesthesia care unit (PACU) stay. Postoperative pain, rescue analgesic requirement, postoperative nausea and vomiting (PONV), adverse events, and patient satisfaction using a 5-point Likert scale were also evaluated. Results: Baseline demographic, clinical, and laboratory characteristics were comparable between the two groups (p>0.05). Group T demonstrated significantly better intraoperative hemodynamic stability with lower heart rate and mean arterial pressure fluctuations following induction, intubation, pneumoperitoneum, and at the end of surgery (p<0.001). Recovery was significantly faster in the TIVA group, with shorter times to spontaneous respiration (4.8±1.3 vs 6.4±1.7 minutes), eye opening (6.5±1.6 vs 9.2±2.1 minutes), extubation (8.4±1.8 vs 11.5±2.4 minutes), orientation (11.4±2.3 vs 15.6±3.0 minutes), and PACU discharge (47.8±8.9 vs 60.5±10.4 minutes) (all p<0.001). Modified Aldrete scores were significantly higher in Group T during early recovery (p<0.001). Postoperative pain scores, rescue analgesic requirement, and incidence of PONV were significantly lower in the TIVA group (p<0.05). Mean patient satisfaction score was significantly higher with TIVA (4.5±0.6 vs 3.9±0.8, p<0.001). Conclusion: Total Intravenous Anaesthesia provided superior intraoperative hemodynamic stability, faster postoperative recovery, lower postoperative pain, reduced postoperative nausea and vomiting, decreased analgesic requirements, and higher patient satisfaction compared with Balanced General Anaesthesia. TIVA represents an effective and safe anaesthetic technique for elective laparoscopic procedures and may be preferred to optimise perioperative outcomes.

Keywords: Total Intravenous Anaesthesia, Balanced General Anaesthesia, Laparoscopic Surgery, Hemodynamic Stability, Recovery Profile, Patient Satisfaction, Propofol, Postoperative Nausea and Vomiting.