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

Abstract

Background Adequate surgical field visualization is imperative for successful outcomes in endoscopic sinus surgery (ESS). The type of anesthetic administered can alter a patient’s hemodynamics and impact endoscopic visualization during surgery. We review the current evidence regarding the effect of total intravenous anesthesia (TIVA) compared to inhalational anesthesia (INA) on visualization of the surgical field during ESS. Methods A systematic review of the literature was performed. Ovid MEDLINE, Scopus, and Cochrane databases were searched from 1946 to January 2012. Citations from the primary search were reviewed and filtered to identify all relevant abstracts in English. Articles meriting full review included prospective controlled trials enrolling adult patients undergoing ESS that were randomized to a group receiving INA or TIVA with outcome measures focused on surgical field visualization. ‘Results Seven eligible trials fulfilled inclusion criteria. Four of the seven articles demonstrated a statistically significant improvement in surgical field grade during ESS when receiving TIVA compared with INA. However, detailed INA concentrations were often not provided. High levels of INA may have been administered; therefore, side effects of INA rather than effects of an ideal INA administration were possibly represented. Analgesic administration also varied widely among the anesthetic groups further complicating interpretation of study results. The lack of power and the heterogeneity of the studies precluded a formal meta-analysis. Conclusions Although several studies reported that TIVA improve surgical conditions in ESS, however there are significant limitations. These findings prevent any definite recommendation at this point, emphasizing the need for further high quality studies.

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

“…15,17,21 Although several studies have concluded that TIVA may improve surgical conditions during the endoscopic sinus surgery, 12,13,22–24 others could not show a difference, 2526–28 and more so, those that did, often had severe limitations in design and/or power to preclude an overall recommendation. 10,14,15 Caution is also warranted because different agents are used in TIVA at different combinations and infusion rates; the same is true for different InhA regimen. Moreover, studies are rarely controlled for the effect of the anesthetic regimen on blood pressure or its determinants cardiac output and systemic vascular resistance.…”

Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial

“…3–12 Results from those studies have been inconsistent, with some authors demonstrating improved surgical field visualization and decreased blood loss, while others failed to find significant differences. Recent systematic reviews came to varying conclusions as well, 2,13,14 suggesting that more high-quality research is needed to further define the role of TIVA for ESS.…”

Hemostasis in sinus surgery

“…This makes true metaanalysis difficult [4]. Total bleeding during FESS is also relatively low, therefore large sample sizes are required to detect statistically significant differences [5 & ,6].…”