Comparison of surgical field visibility during propofol or desflurane anesthesia for middle ear microsurgery

Xia Yuan,Chunbo Hu,Xia Shen,Tingjie Liu

doi:10.1186/s12871-019-0759-x

Abstract

BackgroundTo compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/remifentanil (DR) anesthesia.MethodsA total of 80 adult patients undergoing middle ear microsurgery due to cholesteatoma otitis media with American Society of Anesthesiologists physical status I and II were randomly assigned to the PR or DR groups. The depth of anesthesia was titrated to maintain a Bispectral index (BIS) between 40 and 50. Remifentanil was titrated to maintain the mean blood pressure within ±30% change of the pre-induction value. Surgical field visibility was rated at several timepoints by the surgeons using the Boezaart scores.ResultsAverage Boezaart scores for surgical field visibility at different time points were < 2 in both PR and DR groups. Surgical field visibility score was lower in the PR group than in the DR group. Requirement for remifentanil was higher in the PR group (850 (488/1330) μg) than in the DR group (258 (143/399) μg, P < 0.0001). The site effect concentration of remifentanil was higher in the PR group (3.6(2.8/5.0)ng/ml) than in the DR group (1.7 (1.0/1.6) ng/ml, P < 0.0001). Hemodynamic profile (i.e., heart rate and mean blood pressure) was similar between groups (P > 0.05). Extubation time (PR group, 21 min vs. DR group, 19 min; P = 0.199) and post-anesthesia care unit time (PR group, 37 min vs. DR group, 34 min; P = 0.324) were comparable between groups.ConclusionAlthough PR anesthesia resulted in lower surgical field visibility scores than DR anesthesia, both groups had scores < 2, meaning no clinical differences between the two groups. DR provided acceptable operative conditions as well, albeit more remifentanil consumption was noted in the DR group.Trial registrationChina Clinical Research Information Service, ChiCTR-1,800,015,537. Registered 5 April 2018. Date of enrolment of the first participant to the trial: 2 May 2018.

Highlights

To compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/ remifentanil (DR) anesthesia
Consistent with findings that surgical conditions are correlated with intraoperative heart rate rather than mean blood pressure [6,7,8], propofol anesthesia is associated with a lower intraoperative heart
Age, height, weight, body mass index, anesthesia and surgery times, and distribution of the three surgeons were similar between PR and DR groups (Table 1)

Summary

Introduction

To compare surgical field visibility between patients given propofol/remifentanil (PR) or desflurane/ remifentanil (DR) anesthesia. There is consensus that anesthesia with propofol provides better surgical field visibility and less blood loss than anesthesia with isoflurane or desflurane [5, 6]. Desflurane tends to stimulate circulation (i.e., increase heart rate) and may not be appropriate for middle ear surgery, which demands optimal surgical field visibility. Few studies have compared middle ear surgical field visibility between propofol/remifentanil (PR) and desflurane/remifentanil (DR) anesthesia. We hypothesized that propofol/remifentanil anesthesia may provide better surgical condition than desflurane/remifentanil anesthesia during middle ear microsurgery. We conducted a double-blind, randomized controlled study to assess the effects of desflurane on surgical field visibility, intraoperative hemodynamic profile, and patient recovery from middle ear microsurgery

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