Propofol TIVA vs Sevoflurane: Which Anesthetic Lowers Surgical Inflammation?

When it comes to surgical recovery, controlling inflammation is key. Anesthetic choices play a surprisingly important role in this process, with potential implications for healing, infection risk, and overall outcomes. A new double-blind study published in BMC Anesthesiology takes a closer look at this connection, comparing the effects of two common anesthesia approaches—total intravenous anesthesia (TIVA) with propofol and inhalational anesthesia with sevoflurane—on inflammation in patients undergoing lumbar microdiscectomy, a minimally invasive spine surgery.

Forty patients were randomly assigned to receive either TIVA with propofol or sevoflurane inhalation anesthesia. Researchers measured levels of several inflammatory markers, including interleukin-6 (IL-6), C-reactive protein (CRP), procalcitonin (PCT), and the neutrophil-to-lymphocyte ratio (NLR) before, during, and after surgery.

The findings were striking: patients who received propofol-based TIVA had significantly lower IL-6 and CRP levels 24 hours after surgery than those who received sevoflurane. This suggests that TIVA blunts the usual postoperative spike in these inflammation markers, while sevoflurane is associated with a more pronounced inflammatory response. Interestingly, while baseline NLR was lower in the TIVA group, differences did not persist in the postoperative phase, and PCT levels were similar across both groups.

Why does this matter? Elevated inflammation after surgery isn’t just a laboratory curiosity. It is linked to complications like poor wound healing, infections, and delayed recovery. By carefully choosing anesthetics that reduce inflammatory responses, clinicians may be able to support swifter, safer recoveries—especially in patients who are at higher risk for complications.

This study is notable because most prior research has focused on major or cancer surgeries. By selecting a minimally invasive procedure in otherwise healthy patients, the results provide clearer insight into the direct effects of anesthetic technique, without confounding factors from severe disease or extensive tissue trauma. While the findings are promising for the use of TIVA with propofol in controlling surgical inflammation, the authors caution that larger, multicenter studies and longer-term follow-up are needed to confirm these benefits across a broader range of surgeries and patient populations.

Key Takeaways:

TIVA with propofol resulted in significantly lower post-op IL-6 and CRP levels compared to sevoflurane, indicating less inflammation.

Both anesthetic methods were safe and had comparable outcomes for procalcitonin and NLR.

Minimally invasive surgery allows a clearer view of anesthesia’s effect on inflammation, highlighting TIVA’s potential.

More research is needed to see if these results apply to other surgeries and patient populations.

Citation:

Yediyıldız, M.B., Durmuş, İ., Yılmaz Ak, H., Taşkın, K., Devrüş Ceylan, M.A., Yüce, Y., Çevik, B., & Aydoğmuş, E. (2025). Comparison of inhalation and total intravenous anesthesia on inflammatory markers in microdiscectomy: a double-blind study. BMC Anesthesiology, 25:238. https://doi.org/10.1186/s12871-025-03119-6