The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery.
BACKGROUND
Bleeding during endoscopic sinus surgery (ESS) may increase complications and negatively effect the surgery and its outcome. The aim of this study was to compare the surgical field in patients in whom total intravenous anesthesia (TIVA) is used as opposed to inhalation anesthesia. A prospective randomized controlled trial was performed.


METHODS
Fifty-six patients undergoing ESS were randomly assigned to receive either inhaled sevoflurane with incremental doses of fentanyl (n = 28) or TIVA via a propofol and remifentanil infusion (n = 28) for their general anesthesia. The surgical field was graded every 15 minutes using a validated scoring system.


RESULTS
The two groups were matched for surgical procedure and computed tomography scores. Patients in the TIVA group were found to have a significantly lower surgical grade score than in the sevoflurane group (p < 0.001). Surgical grade score increased with time in both groups. Mean arterial pressure and pulse were found to influence the surgical field independently (p = 0.003 and p = 0.036 respectively). Mean surgical field grade scores were higher in the patients with allergic fungal sinusitis and nasal polyposis as opposed to chronic rhinosinusitis without polyps or fungus. Lund-Mackay computed tomography scores were found to correlate positively with surgical grade (Spearman rank correlation, p = 0.001).


CONCLUSIONS
In patients undergoing ESS, TIVA results in a better surgical field than inhalational anesthesia.
Wormald
Peter J
PJ
Department of Surgery-Otolaryngology, Head and Neck Surgery, The University of Adelaide and Flinders University, Adelaide, South Australia.
van Renen
Graham
G
Perks
Jonathon
J
Jones
Janine A
JA
Langton-Hewer
Claire D
CD
D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation; D016063:Blood Loss, Surgical; D001794:Blood Pressure; D004724:Endoscopy; D005260:Female; D005283:Fentanyl; D006801:Humans; D008297:Male; D008738:Methyl Ethers; D013517:Otorhinolaryngologic Surgical Procedures; D010256:Paranasal Sinuses / Q000601:surgery*; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D000077149:Sevoflurane
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D005283:Fentanyl; D015742:Propofol