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. 2018 Aug 21;2018(8):CD012317. doi: 10.1002/14651858.CD012317.pub2

Tylman 2011.

Methods RCT, parallel design, single‐centre
Participants Total number of randomized participants: 50
Inclusion criteria
  1. Scheduled for elective colorectal surgery


Exclusion criteria
  1. Study authors report that participants with ulcerative colitis and Crohn's disease were excluded after randomization. No other exclusion criteria reported


Types of surgery: colorectal surgery for rectal or colon cancer
Baseline characteristics
TIVA group
  1. Age, median (25 to 75% range): 63 (59 to 72) years

  2. Gender, M/F: 15/10

  3. ASA grade: not reported


Inhalational maintenance group
  1. Age, median (25 to 75% range): 70 (59 to 78) years

  2. Gender, M/F: 16/9

  3. ASA grade: not reported


Country: Sweden
Setting: hospital
Interventions TIVA group
Participants: n = 25; 0 losses
Induction details : propofol TCI 3 µg/mL. Continuous infusion of remifentanil 0.25 µg/kg/min
Maintenance details: propofol 2 µg/mL. Remifentanil 0.15 µg/kg/min
Additional regional anaesthesia: epidural anaesthesia of 5 mg/mL bupivacaine, and 5 µg/mL epinephrine at rate of 4 mL to 5 mL during surgery. Postoperatively participants epidural changed to 1 mg/mL bupivacaine, 2 µg/mL fentanyl, 2 µg/mL epinephrine at rate of 5 mL/hour to 12 mL/hour
Other information: before induction of anaesthesia participants given 1 µg/kg to 2 µg/kg fentanyl IV, and standard dose of rocuronium
Inhalational maintenance group
Participants: n = 25; 4 losses (did not meet study inclusion criteria); 21 analysed
Induction/maintenance details: sevoflurane with 60% O2 throughout surgery. Concentration not reported. We assume that induction was also with sevoflurane
Additional regional anaesthesia: epidural anaesthesia of 5 mg/mL bupivacaine, and 5 µg/mL epinephrine at rate of 4mL to 5 mL during surgery. Postoperatively participants epidural changed to 1 mg/mL bupivacaine, 2 µg/mL fentanyl, 2 µg/mL epinephrine at rate of 5 mL/hour to 12 mL/hour
Other information: fentanyl and rocuronium same as TIVA group
Outcomes
  1. Inflammatory markers

  2. Blood loss

  3. Body temperature

  4. Blood glucose levels

  5. Length of hospital stay

Notes Funding/declarations of interest: not reported
Study dates: not reported
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Participants were randomly assigned to groups; no additional details
Allocation concealment (selection bias) Unclear risk No details
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Not feasible to blind anaesthetist to intervention groups.
Blinding of outcome assessment (detection bias) 
 All outcomes Unclear risk No details
Incomplete outcome data (attrition bias) 
 All outcomes High risk Loss of participants (all in inhalation group) after randomization because these participants were diagnosed with additional conditions (ulcerative colitis and Crohn's disease). Decision to remove these participants was to avoid confounding. Post‐hoc decision which is imbalanced between groups
Selective reporting (reporting bias) Unclear risk Study authors do not report clinical trials registration. Not feasible to judge risk of selective outcome reporting
Other bias Unclear risk Differences in groups in use of remifentanil and fentanyl. Also, study authors do not report concentration of sevoflurane. Note limited information in baseline characteristics table, and lack of inclusion/exclusion criteria