We thank Yonekura et al. for raising the problem of the risk of bias in our meta-analysis. First, we agree that it is almost impossible for anesthesiologists to perform fully blindly either volatile anesthetics or total intravenous anesthesia for anesthesia maintenance. Accordingly, some performance bias in trials comparing two anesthetics is unavoidable. However, such a bias can be markedly reduced if researchers other than anesthesiologists examine data and, more importantly, when outcomes are objective as in our meta-analysis. With regard to the recent article by Landoni et al., the early conclusion of the trial may have in fact underestimated the treatment effect, so the inclusion in our meta-analysis of the published data may in turn have theoretically reduced the treatment effect. Nevertheless, another recent meta-analysis reports low risk of bias with regard to...

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