title: Blood loss during endoscopic sinus surgery with propofol or sevoflurane: a randomized clinical trial.
abstract: OBJECTIVE
  Total intravenous anesthesia (TIVA) with propofol has been associated with reduced operative time, decreased perioperative risks, and decreased intraoperative blood loss compared with inhalational anesthesia (IA). During endoscopic sinus surgery (ESS), reduced bleeding from the mucosal surfaces could improve visualization of the anatomy and decrease the risk of serious complications.
  
  
  OBJECTIVE
  To compare blood loss during ESS between patients receiving TIVA with propofol and those receiving IA with sevoflurane.
  
  
  METHODS
  Prospective, randomized study of 33 patients undergoing ESS in an academic medical center.
  
  
  METHODS
  Patients received either TIVA or IA.
  
  
  METHODS
  The primary outcome was rate of blood loss in milliliters per hour. The secondary outcomes included the quality of visibility measured by the surgeon's numeric rating score, ease of anesthesia as measured by the anesthesiologist's numeric rating score, and total blood loss.
  
  
  RESULTS
  The mean (SEM) blood loss per hour in the TIVA group was 78.5 (14) mL/h, and in the IA group it was 80.3 (17) mL/h (P = .93). A post hoc subgroup analysis found that in patients with a Lund-Mackay score of 12 or lower, the propofol TIVA group had a lower rate of blood loss compared with the sevoflurane IA group (mean blood loss, approximately 18 mL/h vs approximately 99 mL/h). The anesthesiologist's numeric rating score was significantly higher (indicating greater ease of performance) in the IA group than in the TIVA group. There was no statistically significant difference in the surgical numeric rating score between the 2 groups.
  
  
  CONCLUSIONS
  In this comparative study, our results did not show any difference in blood loss and surgical conditions between the TIVA and IA groups. Even further study is not likely to show a difference in blood loss between TIVA and IA during ESS.
authors.affiliation: Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medical Center, Chicago, IL, USA.
authors.forename: Mohamad R
authors.initials: MR
authors.lastname: Chaaban
authors.forename: Fuad M
authors.initials: FM
authors.lastname: Baroody
authors.forename: Ori
authors.initials: O
authors.lastname: Gottlieb
authors.forename: Robert M
authors.initials: RM
authors.lastname: Naclerio
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000503:physiopathology* / Q000706:statistics & numerical data; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D061646:Operative Time; D010254:Paranasal Sinus Diseases / Q000601:surgery; D011379:Prognosis; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D000077149:Sevoflurane; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D000077149:Sevoflurane; D015742:Propofol