Abstract: Objecive To systematically evaluate the efficacy and safety of target controlled infusion（TCI） compared to manually controlled infusion（MCI） with Propofol and Remifentanil for total intravenous anesthesia. Methods Databases including the Cochrane library, the database of the Cochrane anesthesia group,MEDLINE, EMBASE, PubMed, CNKI, VIP and Wanfang data were electronically searched from inception to May 2018 to collect the randomized controlled trials（RCTs） related to the efficacy and safety of TCI compared to MCI with Propofol and Remifentanil for total intravenous anesthesia. Two reviewers independently secreened literature, extracted data,and assessed the risk of bias of included studies. Then statistical analysis was performed using RevMan 5.3 software. Results A total of sixteen RCTs were included, involving 1 131 patients. The results of meta-analyses showed that: Compared with the MCI group, the mean arterial pressure changes during induction period （MD=6.81,95%CI 1.54~12.07, P=0.01）was more stable in the TCI group; The emergence time （MD=-2.32, 95%CI -4.17~-0.48, P=0.01）, spontaneous breathing recovery time （MD=-1.44, 95%CI -2.86~-0.02, P=0.05） and extubation time （MD=-2.41, 95%CI -4.62~-0.19, P=0.03） were significant shorter in the TCI group. The TCI group significantly reduced Propofol dosage （MD=-48.83, 95%CI -87.80~-9.86, P=0.01） and Remifentanil dosage （MD=-116.62,95%CI -218.95~-14.29, P=0.03）, at last, the TCI group decreased the occurrence rate of respiratory depression（RR=0.35,95%CI 0.14~0.84, P=0.02）, but there was no statistically significant difference in the intraoperative awareness,hypotension,bradycardia,restlessnes,nausea and vomiting between the two groups. Conclusion Compared with the MCI group, the TCI group can maintain hemodynamic stability during induction, significantly shorten the recovery time of anesthesia, reduce the dosage of anesthetic drugs, and reduce the incidence of respiratory depression.