Sevoflurane vs. TIVA in Terms of Middle Ear Pressure During Laparoscopic Surgery

Abstract

Objectives. The aim of this study was to investigate the effects of CO 2 insufflation on the pressure of the middle ear cavity (PMEC) during laparoscopic surgery under total intravenous anesthesia (TIVA) with propofol or sevoflurane as an inhalational anesthetic maintenance. Material and Methods. Sixty patients who underwent laparoscopic/or non-laparoscopic surgery under general anesthesia were included in the study. For anesthetic maintenance with inhalation agents, 20 non-laparoscopic surgery patients in Group 1 were applied sevoflurane (2-2.5%). Forty patients who underwent laparoscopic surgery were randomized into two groups. Anesthesia was maintained with sevoflurane (2-2.5%) in twenty patients in Group 2 and the TIVA technique in 20 patients in Group 3. In Group 1, PMEC was measured before anesthesia, 10 and 30 min after endotracheal intubation, 10 min before extubation, and 15, 30, 60 min and 6 hours in the postoperative period. In Group 2 and 3, PMEC was measured before the anesthesia, 10 min after intubation, 10 and 30 min after CO 2 insufflation, just before the CO 2 elimination, 10 min before the extubation, and 15, 30, 60 min and 6 hours after extubation in the postoperative period. Results. PMEC was significantly increased in Group 1 at 10 min after intubation, at 30 min of the operation, before extubation, and at postoperative 15 and 30 min (p < 0.05). In Group 3, differences between PMECs were detected at the 30 th min of insufflation (p = 0.005), and during elimination (p = 0.035) compared to the initial measurement. Generally, the values remained positive in Group 1 and negative in Group 3. There was a significant difference between Group 1 and Group 3 at 10 min after the induction (p = 0.001). There was no statistically significant difference in PMECs between Group 2 and 3 patients undergoing laparoscopic surgery. Conclusions. Our results indicate that, in laparoscopic surgery, TIVA used for the maintenance of anesthesia did not increase the PMEC and the changes caused by sevoflurane were also in the normal range of middle ear pressures. In patients with previous ear surgery, if there is a need of classical surgical procedures in the future, sevoflurane anesthesia should not be the first choice due to its effects on PMEC, which cause it to be increased over 50 daPa, especially at 30 min after intubation. Patient characteristics including previous ear surgery should be considered in selecting the optimum anesthetic agents and technique (Adv Clin Exp Med 2014, 23, 3, 447-454).

Effects of steep Trendelenburg position and pneumoperitoneum on middleear pressure in patients undergoing robotic radical prostatectomy

“…Results of clinical studies suggested that volatile anesthetics might cause an increase in MEP and total intravenous anaesthesia (TIVA) was the optimal choice to maintain MEP within the normal range (11,12,18,19). In this study, to isolate the effects of Trendelenburg position combined with pneumoperitoneum independently of the effects of anesthesia, TIVA with propofol and remifentanil was preferred.…”

“…The MEP is regulated by the Eustachian tube, the gas exchange through the middle ear mucosa, and central neural mechanisms (14,16). Studies showed that, besides diseases related to the middle ear, sleeping, body position, and anesthesia also play an important role in regulation of the MEP (11)(12)(13)(14)17). Cinamon et al (13) studied the MEP changes related to body position and concluded that body posture had a significant, immediate, and reversible effect on MEP.…”

“…The middle ear cavity is covered by mucosa filled with gas and has a constant pressure during physiologically normal activities (9). Increase in MEP causes an increase in intratympanic pressure, which may result in membrane rupture and hearing loss (10,11). It was reported that factors such as supine position, general anesthesia, and airway management increased the MEP (12)(13)(14).…”

Effects of Total Intravenous Anesthesia and Low- and High-Flow Anesthesia Implementation on Middle Ear Pressure

“…Arrhythmias and myocardial depression occur rarely, and the emergence is faster, making it an advantageous anesthetic method. In their study, Güler et al [ 10 ] recommended TIVA for laparoscopic surgery, since the pressures followed a low course in the TIVA group. They reported that sevoflurane did not increase the ear pressure above 50 daPa and that there were no inconveniences related to its use, but optimum anesthetic agents must be used for those undergoing ear surgery.…”

Acute Intraoperative Tympanic Membrane Rupture in Patient Anesthetized With Desflurane Without Nitrous Oxide: A Case Report

“…Evidence supports this notion; desflurane increases MEP to a greater extent than either sevoflurane or isoflurane. 6,7,9,10 All 3 of these modern agents have a less pronounced increase in MEP compared to N 2 O. Normal MEP for adults has been shown to be ± 7.5 mm Hg while TM rupture is known to occur at an average MEP of 290 mm Hg.…”