Karthikeyan 2002.

Methods	RCT, parallel design
Participants	61 adult participants Elective procedures for atrial fibrillation or atrial flutter ASA I/II/III Hospital, UK
Interventions	Propofol (TCI at 6 µg/mL continued throughout procedure) Sevoflurane (8% sevoflurane inhaled in 50% oxygen/nitrous oxide)    Both groups given nitrous oxide as co‐induction. Also both given glycopyrronium 200 µg iv during 3‐minute preoxygenation period Aim: loss of eyelash reflex
Outcomes	Unintended apneic episodes Success of cardioversion PONV Pain at site of injection Myoclonus Time to loss of consciousness Time to awakening Patient satisfaction
Results	Propofol vs Sevoflurane Hypotension: no definition of hypotension given. Study authors state: "Both agents were associated with decreased blood pressure after induction, but the patients in the propofol group had significantly lower systolic and diastolic pressures in the recovery room" Apnoea: 8/31 vs 5/30 PONV: 1/31 vs 2/30 Pain at site of injection: 4/31 vs 0/30 Myoclonus (defined as movements): 6/31 vs 3/30 Return to sinus rhythm: 29/31 vs 25/30 Patient satisfaction, opinion of anaesthetic: pleasant 11/31 vs 10/30; indifferent 13/31 vs 11/30; unpleasant 1/31 vs 1/30
Notes	Propofol/nitrous oxide dose high
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer‐generated random numbers
Allocation concealment (selection bias)	Unclear risk	No details
Blinding of participants and personnel (performance bias) Major adverse events	High risk	No details of whether anaesthetist was blinded. Assumed not blinded
Blinding of participants and personnel (performance bias) Patient reported outcomes (recall/satisfaction)	High risk	No details of whether anaesthetist was blinded. Assumed not blinded
Blinding of participants and personnel (performance bias) Success of cardioversion	Unclear risk	No details of whether cardiologist/clinician was blinded
Blinding of participants and personnel (performance bias) Minor adverse events	High risk	No details of whether anaesthetist was blinded. Assumed not blinded
Blinding of participants and personnel (performance bias) Time to induction etc/need for resedation.	High risk	No details of whether anaesthetist was blinded. Assumed not blinded
Blinding of outcome assessment (detection bias) Major adverse event	Unclear risk	No details of who assessed outcomes and whether blinded
Blinding of outcome assessment (detection bias) Patient reported outcomes (recall/satisfaction)	Unclear risk	No details of whether participants were blinded
Blinding of outcome assessment (detection bias) Success of cardioversion	Unclear risk	No details of who assessed outcomes and whether blinded
Blinding of outcome assessment (detection bias) Minor adverse events	Unclear risk	No details of who assessed outcomes and whether blinded
Blinding of outcome assessment (detection bias) Time to induction etc./need for resedation	Unclear risk	Time to awakening measured by a recovery nurse unaware of group allocation However, no details of who reported other time outcomes
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses
Selective reporting (reporting bias)	Unclear risk	All outcomes from methods section reported Prepublished protocol not sought
Other bias	High risk	Baseline characteristics comparable. However dose of propofol/nitrous oxide is high, which could bias the results