Lindholm 2013.

Methods	RCT, parallel design, single‐centre
Participants	Total number of randomized participants: 200 Inclusion criteria People with AAA or aortic arteriosclerosis obliterans, or both, scheduled for open abdominal aortic surgery Excluded criteria < 18 years of age Included in other pharmaceutical studies Abuse of opioids, benzodiazepines, antiepileptic drugs, alcohol, or alpha2‐agonists Pregnant and breastfeeding women Family history of malignant hyperthermia Known hypersensitivity for opioids, propofol, or volatile anaesthetics Serious arrhythmias, ventricular fibrillation/tachycardia or tachycardia > 100 beats/min Severe valvular diseases requiring surgical repair before major noncardiac surgery Uncontrolled hypertension Serious psychiatric disease Unstable angina pectoris or MI 30 days before inclusion Acute abdominal aortic surgery Planned laparoscopic AAA surgery Type of surgery: open abdominal aortic surgery Baseline characteristics TIVA group Age, mean (SD): 67 (± 9) years Gender, M/F: 72/24 ASA grade: ASA II: 34; ASA III: 49; ASA IV: 13 Inhalational maintenance group Age, mean (SD): 69 (± 9) years Gender, M/F: 73/24 ASA grade: ASA II: 36; ASA III: 47; ASA IV: 14 Country: Norway Setting: hospital
Interventions	TIVA group Participants: n = 100; losses unclearly reported; 96 analysed (PP) Induction details : premedication with paracetamol. Fentanyl 0.1 mg to 0.3 mg IV, and propofol 1 mg/kg to 2 mg/kg IV. Vecuronium 0.1 mg/kg, and 0.01 mg/kg to 0.02 mg/kg based on train‐of‐four Maintenance details: propofol 1 mg/kg/hour to 10 mg/kg/hour IV, and remifentanil 0.1 mg/kg/min to 0.7 mg/kg/min. Aim to maintain BIS 40 to 60. Additional regional anaesthesia: epidural 3 mL/hour to 12 mL/hour (bupivacaine 1 mg/mL, fentanyl 2 µg/mL, adrenaline 2 µg/mL) Other information: morphine 1 mg to 10 mg IV as rescue analgesia Inhalational maintenance group Participants: n = 100; losses unclearly reported; 97 analysed (PP) Induction details : premedication with paracetamol as for TIVA. Fentanyl 0.1 mg to 0.3 mg IV and thiopental sodium 3 mg/kg to 6 mg/kg IV. Vecuronium as for TIVA Maintenance details: balanced anaesthesia with sevoflurane at 0.7 MAC to 1.5 MAC, and repeated doses of fentanyl 0.05 mg to 0.1 mg IV. Aim to maintain BIS 40 to 60 Additional regional anaesthesia: epidural 3 mL/hour to 12 mL/hour (bupivacaine 1 mg/mL, fentanyl 2 µg/mL, adrenaline 2 µg/mL) Other information: morphine same as TIVA group
Outcomes	Troponin T levels on first postoperative day Postoperative complications, to included cognitive dysfunction (at 30 days) Non‐fatal coronary events including acute MI Non‐thrombotic troponin increase Mortality (at 30 days) Use of inotropic‐, vasodilator‐ , and anaesthetic drugs Bleeding, urine output, tachycardia, bradycardia, hypotensive and hypertensive episodes during surgery Ischaemic events Arrhythmias Fluids and transfusions Postoperative pain Nausea and vomiting SOFA scores at 8 hours and first and second postoperative days Length of ward or ICU stay Length of hospital stay
Notes	Funding/declarations of interest: institution or department funding. One author received fees for presentations at Baxter AS Norway Study dates: February 2008 to February 2012
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Participants were randomized to groups; no additional details
Allocation concealment (selection bias)	Unclear risk	Quote: "after informed consent was given, patients selected a blank envelope with the randomization code inside from a box containing envelopes for all remaining patients to be included." Study does not report if envelopes were opaque and sealed. Unclear if this is a sufficient method to conceal group allocation
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not feasible to blind anaesthetists to intervention groups
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Postoperative care was blinded. However, study authors do not report who collected data for POCD
Incomplete outcome data (attrition bias) All outcomes	Low risk	Small loss of participant data. Reasons for losses are unclearly reported, however loss is < 10% and balanced between groups
Selective reporting (reporting bias)	Unclear risk	Prospective registration with clinical trials register (NCT00538421). However, outcomes are not reported in trials register documents; not feasible to assess risk of selective outcome reporting bias
Other bias	Unclear risk	Groups differ in use of fentanyl and remifentanil which presents methodological differences between groups