Comparative analysis of the effects of inhalational and intravenous anesthetics on hemodynamic variability and cardiovascular complications in patients undergoing general anesthesia – a review of current evidence
DOI:
https://doi.org/10.12775/JEHS.2026.90.70551Keywords
inhalation anesthetics, intravenous anesthetics, hemodynamic stability, cardiovascular complications, general anesthesiaAbstract
Background. Patient hemodynamic stability during general anesthesia is a crucial factor, managing which helps avoid many complications, especially cardiovascular ones. Intravenous and inhaled anesthetics affect the human body differently, have different mechanisms of action, and have different durations of action. Due to the diversity of anesthetics, it is essential to match them appropriately to the patient's medical history and current clinical condition to reduce the risk of possible postoperative complications.
Aim. The aim of this study was to analyze the inhalation and intravenous anesthetics used by anaesthesiologists and their impact on the hemodynamic stability of patients and, consequently, the risk of cardiovascular complications.
Material and methods. This paper provides a literature review of inhaled and intravenous anesthetics used in clinical practice. Research papers available in PubMed, Google Scholar, and ScienceDirect were analyzed. The focus was on clinical trials, meta-analyses, and review articles.
Conclusions. Intravenous and inhaled anesthetics differ in their action profile and impact on the circulatory system. Inhaled drugs provide greater hemodynamic stability, while intravenous drugs are characterized by a faster onset of action and a less predictable effect on the patient's vital signs. Due to the advantages of both groups of anesthetics, the selection of anesthesia should be individualized for each patient, taking into account their health status, comorbidities, and the risk of thromboembolic events.
References
1. Beverstock J., Park T., Alston R.P., Song C.C.A., Claxton A., Sharkey T., Hutton S., Fathers J., Cawley W., A Comparison of Volatile Anesthesia and Total Intravenous Anesthesia (TIVA) Effects on Outcome From Cardiac Surgery: A Systematic Review and Meta-Analysis, J Cardiothorac Vasc Anesth. 2021 Apr;35(4):1096-1105
2. Carron M., Tessari I., Linassi F., Navalesi P., Desflurane versus propofol for general anesthesia maintenance in obese patients: A pilot meta-analysis, J Clin Anesth. 2021 Feb;68:110103
3. Chen S.J., Yuan X.Q., Xue Q., Lu H.F., Chen G., Current research progress of isoflurane in cerebral ischemia/reperfusion injury: a narrative review, Med Gas Res. 2022 Jul-Sep;12(3):73-76
4. De Hert S., Staender S., Fritsch G., et al., Pre-operative evaluation of adults undergoing elective noncardiac surgery, European Journal of Anaesthesiology. 2018;35(6):407–465
5. Dhande K., Kshirsagar J., Dhande A., Patil N., V P Jr., Hemodynamic Stability, Patient Acceptance and Cost of Intravenous Propofol and Inhalational Sevoflurane for Induction of Anaesthesia: A Prospective, Randomized Comparative Study. Cureus. 2020 Apr 16;12(4):e7687
6. Gao Y., Liu L., Zhao B., Wang Y., Yu S., Wang H., Effect of General and Non-general Anesthesia on Postoperative Cognitive Dysfunction, J Coll Physicians Surg Pak. 2020 Apr;30(4):407-411
7. Jozwiak M., Teboul J.L., Heart-Lungs interactions: the basics and clinical implications, Ann Intensive Care. 2024 Aug 12;14(1):122
8. Kassab N., Abourjeili J., Eid M.J., Raphael C.K., Pharmacogenomics of commonly used intravenous anesthetics, Pharmacogenet Genomics., 2026 Mar 1;36(2):25-31
9. Kong E., Nicolaou N., Vizcaychipi M.P., Hemodynamic stability of closed-loop anesthesia systems: a systematic review, Minerva Anestesiol. 2020 Jan;86(1):76-87
10. Kumakura M., Hara K., Sata T., Sevoflurane-associated torsade de pointes in a patient with congenital long QT syndrome genotype 2, J Clin Anesth. 2016 Sep;33:81-5
11. Li M., You W., Chi X., Nie M., Xie A., Sevoflurane vs Propofol Anaesthesia and the Risk of Perioperative Acute Kidney Injury, J Coll Physicians Surg Pak., 2025 Apr;35(4):480-485
12. Lim H.S., González-Costello J., Belohlavek J., Zweck E., Blumer V., Schrage B., Hanff T.C., Hemodynamic management of cardiogenic shock in the intensive care unit, J Heart Lung Transplant. 2024 Jul;43(7):1059-1073
13. Meco B.C., Guclu C.Y., Berger-Estilita J., Radtke F.M., The way towards ethical anesthesia care: no aim - no game - no fame or blame?, Curr Opin Anaesthesiol. 2024 Aug 1;37(4):432-438
14. Moscarelli M., Terrasini N., Nunziata A., Punjabi P., Angelini G., Solinas M., et al., A Trial of Two Anesthetic Regimes for Minimally Invasive Mitral Valve Repair,. J Cardiothorac Vasc Anesth 2018;32:2562–9
15. Negrini D., Wu A., Oba A., Harnke B., Ciancio N., Krause M., Clavijo C., Al-Musawi M., Linhares T., Fernandez-Bustamante A., Schmidt S., Incidence of Postoperative Cognitive Dysfunction Following Inhalational vs Total Intravenous General Anesthesia: A Systematic Review and Meta-Analysis, Neuropsychiatr Dis Treat. 2022 Jul 15;18:1455-1467
16. Obara S., Kamata K., Nakao M., Yamaguchi S., Kiyama S., Recommendation for the practice of total intravenous anesthesia, J Anesth. 2024 Dec;38(6):738-746
17. Pinsky M.R, Cecconi M., Chew M.S., De Backer D., Douglas I., Edwards M., Hamzaoui O., Hernandez G., Martin G., Monnet X., Saugel B., Scheeren T.W.L., Teboul J.L., Vincent J.L., Effective hemodynamic monitoring, Crit Care. 2022 Sep 28;26(1):294
18. Prior C.H., Burlinson C.E.G., Chau A., Emergencies in obstetric anaesthesia: a narrative review, Anaesthesia. 2022 Dec;77(12):1416-1429
19. Qin H., Zhou J., Myocardial Protection by Desflurane: From Basic Mechanisms to Clinical Applications, J Cardiovasc Pharmacol., 2023 Sep 1;82(3):169-179
20. Sahinovic MM, Struys MMRF, Absalom AR. Clinical Pharmacokinetics and Pharmacodynamics of Propofol. Clin Pharmacokinet. 2018 Dec;57(12):1539-1558
21. Schep L.J., Slaughter R.J., Watts M., Mackenzie E., Gee P., The clinical toxicology of ketamine, Clin Toxicol (Phila), 2023 Jun;61(6):415-428
22. Smeltz A.M., Serrano R.A., Total Intravenous Anesthesia Is Preferred Over Volatile Agents in Cardiac Surgery, J Cardiothorac Vasc Anesth. 2024 Oct;38(10):2477-2481
23. Villa G., Husain-Syed F., Saitta T., Degl'Innocenti D., Barbani F., Resta M., Castellani G., Romagnoli S., Hemodynamic Instability during Acute Kidney Injury and Acute Renal Replacement Therapy: Pathophysiology and Clinical Implications, Blood Purif. 2021;50(6):729-739
24. Wang Y., Ming X.X., Zhang C.P., Fluorine-Containing Inhalation Anesthetics: Chemistry, Properties and Pharmacology, Curr Med Chem. 2020;27(33):5599-5652
25. Wunsch H., Bosch N.A., Law A.C., Vail E.A., Hua M., Shen B.H., Lindenauer P.K., Juurlink D.N., Walkey A.J., Gershengorn H.B., Evaluation of Etomidate Use and Association with Mortality Compared with Ketamine among Critically Ill Patients, Am J Respir Crit Care Med. 2024 Nov 15;210(10):1243-1251
26. Xu J., Ye Y., Shen H., Li W., Chen G., Sevoflurane: an opportunity for stroke treatment, Med Gas Res., 2024 Dec 1;14(4):175-179
27. Zanos P, Moaddel R, Morris PJ, Riggs LM, Highland JN, Georgiou P, Pereira EFR, Albuquerque EX, Thomas CJ, Zarate CA Jr, Gould TD. Ketamine and Ketamine Metabolite Pharmacology: Insights into Therapeutic Mechanisms. Pharmacol Rev. 2018 Jul;70(3):621-660
28. Zhang H., Li H., Zhao S., Bao F., Remimazolam in General Anesthesia: A Comprehensive Review of Its Applications and Clinical Efficacy, Drug Des Devel Ther. 2024 Aug 5;18:3487-349
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sandra Drabik, Maja Gałuszka, Aleksandra Gałuszka, Kamila Krycia, Karolina Mazur, Karolina Różycka, Magdalena Mulawa, Emilia Piaszczyńska, Dominika Matacz, Adrianna Adamczyk

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 70
Number of citations: 0