Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

Gollapudy, Suneeta; Poetker, David M.; Sidhu, Jasmeet; Riess, Matthias L.

doi:10.1016/j.amjoto.2018.06.018

Cited by 14 publications

(13 citation statements)

References 33 publications

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“…Sixth, we did not compare clinically important outcomes, such as intraoperative hemodynamics and recovery profiles from anesthesia, between sevoflurane and propofol groups. However, previous studies showed no clinically significant differences in terms of perioperative hemodynamics, intraoperative thermoregulation and blood loss, time to extubation, length of stay in the post‐anesthesia recovery room, and operating conditions between sevoflurane and propofol anesthesia for ETS 23‐27 . Lastly, the non‐inferiority margin was as high as 9% in this study.…”

Section: Discussioncontrasting

confidence: 62%

Effects of anesthetics on post‐operative 3‐month neuroendocrine function after endoscopic transsphenoidal non‐functional pituitary adenoma surgery

Yhim

Yoon

et al. 2020

Acta Anaesthesiol Scand

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Background: Anesthetic techniques can affect perioperative neuroendocrine function. The objective of this study was to compare 3-month post-operative neuroendocrine functional outcomes between sevoflurane and propofol anesthesia in patients undergoing endoscopic transsphenoidal surgery (ETS) for removal of non-functional pituitary adenomas (NFPAs) retrospectively. Methods: Among 356 patients who underwent ETS for removal of NFPAs under sevoflurane-remifentanil anesthesia (sevoflurane group, n = 103) or propofolremifentanil anesthesia (propofol group, n = 253), 92 patients in each group were selected and their 3-month post-operative neuroendocrine functional outcomes (primary outcome measure) were compared after propensity score matching. Results: Overall changes in post-operative 3-month neuroendocrine function compared to pre-operative baseline did not differ between the sevoflurane and propofol groups (worsened: 32.6% vs 29.3%, persistently decreased: 9.8% vs 12.0%, improved: 12.0% vs 20.7%, normalized: 9.8% vs 12.0%, persistently normal: 18.5% vs 19.6%; P = .400). The incidence of pituitary hormone deficiency at 3 months postoperatively did not differ between the sevoflurane and propofol groups (adreno

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Section: Discussioncontrasting

confidence: 62%

Effects of anesthetics on post‐operative 3‐month neuroendocrine function after endoscopic transsphenoidal non‐functional pituitary adenoma surgery

Yhim

Yoon

et al. 2020

Acta Anaesthesiol Scand

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“…20 Despite this data, studies have been inconclusive due to variable TIVA infusion rates/doses decreasing the reliability of the results. 29 Additionally, nomograms and available cerebral monitors, such as bispectral index (BIS) monitoring, utilized for intravenous anesthesia can create variation for serum and cerebral concentrations for propofol. A recent Cochrane review noted a large number of RCTs showing that general anesthesia with BIS had earlier recovery time and decreased risk of intraoperative awareness when compared to anesthesia without BIS.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

Moffatt

McQuitty

Wright

et al. 2021

Am J Rhinol�Allergy

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Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

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“…15 However, in studies by Fish et al and Gollapudy et al, no difference in recovery room time between TIVA and inhaled anesthesia was shown. 16,17 Finally, an article by Gupta et al suggested that early recovery times were shorter with inhaled anesthetics and not TIVA. 18 Thus, the literature is in disagreement on these time-based parameters, and further study is needed to understand when TIVA or inhaled anesthetics are advantageous for the patient.…”

Section: Discussionmentioning

confidence: 99%

Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea

et al. 2020

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Objectives/Hypothesis: There is currently no standard of care in terms of anesthesia modality for patients receiving upper airway surgery with comorbid obstructive sleep apnea (OSA). Although both total intravenous anesthesia (TIVA) and volatile gas anesthesia are commonly utilized in ambulatory otolaryngology surgery, it is currently unclear if there are any advantages with one modality over the other. We hypothesize that patients receiving upper airway surgery with comorbid OSA will have quicker recovery times with TIVA. Study Design: Retrospective chart review from January 2019 to December 2019. Methods: All patients aged 18 and older receiving upper airway surgery (upper airway stimulation, nasal surgery, modified uvulopalatopharyngoplasty) were included. Patients were excluded when there was incomplete or missing data in the electronic medical record. Results: Eighty-six patients received gas anesthesia and 62 patients received TIVA. Phase I recovery times were significantly reduced by surgery and by severity of OSA: nasal surgery, upper airway stimulation, and modified uvulopalatopharyngoplasty had a reduction of 35.5 minutes (P < .001), 42.5 minutes (P < .001), and 36 minutes (P = .022), respectively. In terms of severity, mild, moderate, and severe OSA had reductions of 23.5 minutes (P = .004), 52 minutes (P = .004), and 47 minutes (P < .001), respectively. The severity of OSA generally correlated with increased time spent in Phase I: as severity increased, Phase I time increased by 16.8 minutes for the gas cohort (P < .001), whereas in the TIVA cohort, it increased only 4.3 minutes (P = .489). Conclusion: Patients having upper airway surgery with comorbid OSA that received TIVA (propofol and remifentanil) spent significantly less time in Phase I and the recovery room overall compared to those receiving volatile gas anesthesia in the form of sevoflurane, and this correlated with the severity of OSA.

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Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

Abstract: Our study shows no evidence that total intravenous anesthesia is superior to inhaled anesthesia or vice versa during endoscopic transsphenoidal sinus surgery with regard to relevant clinical outcome parameters.

Cited by 14 publications

References 33 publications

Effects of anesthetics on post‐operative 3‐month neuroendocrine function after endoscopic transsphenoidal non‐functional pituitary adenoma surgery

Effects of anesthetics on post‐operative 3‐month neuroendocrine function after endoscopic transsphenoidal non‐functional pituitary adenoma surgery

Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

Reduced Recovery Times with Total Intravenous Anesthesia in Patients with Obstructive Sleep Apnea

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