title: Pilot study comparing total intravenous anesthesia to inhalational anesthesia in endoscopic sinus surgery: novel approach of blood flow quantification.
abstract: OBJECTIVE
  We compared anesthesia with sevoflurane-remifentanil hydrochloride (SR) to total intravenous anesthesia with propofol-remifentanil hydrochloride (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in terms of sinonasal mucosal blood flow, the surgical field visualization score, and blood loss.
  
  
  METHODS
  We performed a double-blinded prospective study at a tertiary care center in 23 adults scheduled to undergo endoscopic sinus surgery for chronic rhinosinusitis. The patients were randomized to receive SR or PR. The sinonasal mucosal blood flow was measured by optical rhinometry. The surgical field visualization score was based on the Boezaart scale.
  
  
  RESULTS
  The groups had similar clinical characteristics. During the 60- to 90-minute and 90- to 120-minute operative time windows, the blood flow was significantly greater in the PR group than in the SR group (p = 0.04 and p = 0.03, respectively). The amounts of blood loss in the PR and SR groups were 152.9 +/- 161.3 mL and 355.9 +/- 393.4 mL, respectively (p = 0.12). The median ratios of the surgical field visualization score to the number of sinuses operated on in the PR and SR groups were 2.1 and 1.8, respectively (p = 0.52).
  
  
  CONCLUSIONS
  The intraoperative blood flow, as determined by optical rhinometry, was significantly greater with anesthesia with PR than with anesthesia with SR, 1 hour into the procedure; however, this difference did not translate into differences in the amounts of operative blood loss or in the surgical field visualization scores.
authors.affiliation: Dept of Otorhinolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston, 6431 Fannin St, MSB 5.036, Houston, TX 77030, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gomez-Rivera
authors.forename: Davide
authors.initials: D
authors.lastname: Cattano
authors.forename: Uma
authors.initials: U
authors.lastname: Ramaswamy
authors.forename: Chirag B
authors.initials: CB
authors.lastname: Patel
authors.forename: Alfonso
authors.initials: A
authors.lastname: Altamirano
authors.forename: Li-Xing
authors.initials: LX
authors.lastname: Man
authors.forename: Amber
authors.initials: A
authors.lastname: Luong
authors.forename: Zhongxue
authors.initials: Z
authors.lastname: Chen
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Citardi
authors.forename: Samer
authors.initials: S
authors.lastname: Fakhri
mesh_terms: D000328:Adult; D000368:Aged; D000769:Anesthesia, Inhalation; D000771:Anesthesia, Intravenous; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004311:Double-Blind Method; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000098:blood supply*; D010865:Pilot Projects; D010880:Piperidines / Q000008:administration & dosage; D015742:Propofol / Q000008:administration & dosage; D011446:Prospective Studies; D000077208:Remifentanil; D012220:Rhinitis / Q000601:surgery*; D000077149:Sevoflurane; D012852:Sinusitis / Q000601:surgery*
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D010880:Piperidines; D000077149:Sevoflurane; D000077208:Remifentanil; D015742:Propofol