Effects of Sevoflurane Versus Propofol Total Intravenous Anaesthesia on Renal Function in Elderly Patients Undergoing Hip Fracture Surgery: A Randomised Controlled Trial

Abstract

Purpose: The impact of propofol-based total intravenous anaesthesia (TIVA) versus sevoflurane anaesthesia on renal function remains uncertain. We investigated the effect of anaesthetic type (propofol or sevoflurane) on renal function in elderly patients undergoing hip fracture surgery. Patients and Methods: In this randomised controlled trial, 66 elderly patients scheduled for hip fracture surgery were randomly allocated to either propofol or sevoflurane maintenance anaesthesia. The primary outcome was estimated glomerular filtration rate (eGFR) 1 hour postoperatively. Results: The mean age was 70 yr and 53% were female. Compared with the sevoflurane group, the propofol group exhibited significantly higher eGFR levels at 1 hour postoperatively (mean [SD]: 89.4 [13.4] vs 80.1 [17.3] mL min−1 1.73m−2; difference=9.34 mL min−1 1.73m−2; 95% CI, 1.88 to 16.80 mL min−1 1.73m−2; P=0.017). In the secondary outcomes, the propofol group demonstrated significantly higher urine output during anaesthesia (difference=1.11 mL−1 kg−1 h−1; 95% CI, 0.65 to 1.57 mL−1 kg−1 h−1; q<0.001), as well as significantly greater urinary sodium excretion both during anaesthesia (difference=2.88 mmol h−1; 95% CI, 2.02 to 3.75 mmol h−1; q<0.001) and in the first 2 postoperative hours (difference=5.08 mmol h−1; 95% CI, 3.20 to 6.97 mmol h−1; q<0.001). Plasma renin levels were significantly lower in the propofol group both during anaesthesia (difference=−93.60 mIU L−1; 95% CI, −108.32 to −78.87 mIU L−1; q<0.001) and at 1 h postoperatively (difference=−27.90 mIU L−1; 95% CI, −42.62 to −13.17 mIU L−1; q<0.001). All other secondary and safety outcomes were comparable between groups. After adjustment for baseline covariates, the analysis yielded consistent results. In subgroup analyses, there was no significant difference in eGFR at 1 hour postoperatively between the propofol and sevoflurane groups. Conclusion: Propofol-based TIVA was associated with higher eGFR at 1 hour postoperatively, along with increased urine output, greater urinary sodium excretion, and lower plasma renin levels during anaesthesia in elderly patients compared with sevoflurane anaesthesia. These findings warrant further investigation to determine their implications for long-term renal outcomes and intraoperative fluid management in this vulnerable population. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2300070049).