Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery

Abstract

Background:An important requirement during functional endoscopic sinus surgery is to maintain a clear operative field to improve visualization during surgery and to minimize complications.Materials and Methods:We compared total intravenous anesthesia using propofol with inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. It was a prospective study in a tertiary hospital in India. Forty ASA physical status I and II adult patients (16–60 years) were randomly allocated to one of two parallel groups (isoflurane group, n = 20; propofol group, n = 20). The primary outcome was to know whether total intravenous anesthesia using propofol was superior to inhalational anesthesia using isoflurane for controlled hypotension. The secondary outcomes measured were intraoperative blood loss, duration of surgery, surgeon's opinion regarding the surgical field and the incidence of complications.Results:The mean (±SD) time to achieve the target mean blood pressure was 18 (±8) minutes in the isoflurane group and 16 (±7) minutes in the propofol group (P = 0.66). There was no statistically significant difference (P = 0.402) between these two groups in terms of intraoperative blood loss and operative field conditions (P = 0.34).Conclusions:Controlled hypotension can be achieved equally and effectively with both propofol and isoflurane. Total intravenous anesthesia using propofol offers no significant advantage over isoflurane-based anesthetic technique in terms of operative conditions and blood loss.

Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia

“…In one study only the anesthesia personnel assessing intraoperative blood loss was blinded to the type of anesthetic used, not the surgeon. 21 In four studies the surgeon was blinded to the type of anesthetic. Blinding was often performed by having a covered infusion pump for propofol set up in every room and a covered volatile anesthetic vaporizer.…”

Comparative Evaluation of Oral Clonidine and Oral Atenolol as Premedication in Functional Endoscopic Sinus Surgery (FESS) Under General Anaesthesia

“…Accordingly, the surgeon was more satisfied with the surgical field in the clonidine group than with that in the placebo group. Also Jabalamelli [16] and Masood Mohseni et al [11] reported that bleeding severity was significantly lesser in clonidine group. Similar to our study, they concluded that premedication with oral clonidine 0.2 mg can effectively reduce bleeding during FESS.…”

“…Several methods have been designed to reduce bleeding during surgery, none of these techniques have consistently provided a desirable bloodless field for the surgeon. So to provide optimal field hypotensive agents given such as sodium nitroprusside, nitroglycerine, propofol, clonidine, esmolol, metoprolol & atenolol had been used individually to decrease blood loss in FESS [9,10,11].…”

Anaesthetic Concerns for Functional Endoscopic Sinus Surgery

“…However, more recent studies do not show significant difference after excluding the effect of concomitant use of remifentanil [29][30][31] .…”