Total IV Anesthesia vs Inhaled Anaesthesia for Intraoperative Visualization During Endoscopic Sinus Surgery: A Double-blind, Randomized Controlled Trial

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Total IV Anesthesia vs Inhaled Anaesthesia for Intraoperative Visualization During Endoscopic Sinus Surgery: A Double-blind, Randomized Controlled Trial
Key Take-Away: 

Endoscopic sinus surgery (ESS) is helpful for the treatment of chronic rhinosinusitis refractory to the conservative measures. In this trial, used as an adjunct to standard perioperative methods to reduce blood loss, the total intravenous anesthesia (TIVA) in comparison with volatile anesthetic improves intraoperative visualization during ESS.

Introduction:

Bleeding during endoscopic sinus surgery (ESS) can impede visualization and delay the surgical progress. The role that the anesthetic technique may have on the quality of the surgical field during ESS has been previously studied. But, the meta-analyses have considered the current literature inconclusive and lacking methodological consistency. This study was devised keeping these critiques in mind to assess the effect of TIVA versus inhaled anesthetic on the quality of surgical field during ESS.

 

Methods:

This study was a double-blind, randomized, controlled trial comprising 30 patients of American Society of Anesthesiologists (ASA) class 1 or 2. These patients were undergoing bilateral ESS for a primary diagnosis of chronic rhinosinusitis. Alongwith standard techniques to minimize blood loss, study patients were randomized to maintenance anesthesia with intravenous propofol or inhaled desflurane. Anesthetic depth was standardized via the bispectral index (BIS). The primary outcome comprised of the Wormald grading scale to examine the endoscopic surgical field.

 

Results:

The use of TIVA was concerned with a statistically significant reduction in mean Wormald score as compared to desflurane (4.21 vs 5.53, p = 0.024). Mean Boezaart score also decreased in TIVA arm (2.18 vs 2.76, p = 0.034). Experimental groups were homogeneous in all compared baseline characteristics. The secondary outcomes plus surgical duration, time to extubation, and estimated blood loss were not found to be statistically significant between the experimental groups.

 

Conclusion:

Although with all other factors implemented to optimize the surgical field, utilization of TIVA versus inhaled anesthetic still caused a statistically significant improvement in the surgical field during ESS.

Source

Int Forum Allergy Rhinol

Link:

https://www.ncbi.nlm.nih.gov/pubmed/30198644

Original title of article:

Total intravenous anesthesia vs inhaled anesthetic for intraoperative visualization during endoscopic sinus surgery: a double blind randomized controlled trial

Authors:

Little M et al.

Exploratory, Propofol, Desflurane, Sinus, Anesthesia, Randomized clinical trial, Wormald grading scale, Boezaart score, Intravenous, Inhaled
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