Abstract
Background The middle ear is an air-filled lacuna in the temporal bone. Inhaled anesthetic agents increase the pressure of this lacuna. Therefore, attention must be paid in choosing not only anesthetic agents but also anesthetic method. Aim This study compared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear pressure. Study Design Randomized prospective double-blind study. Methods In this retrospective double-blind study, 90 patients (20–65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow desflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). The hemodynamic and respiratory parameters and tympanometry were measured before induction (T1), 10 minutes after intubation (T2), 10 minutes before the end of the operation (T3), and 5 (T4), 10 (T5), 15 (T6), and 30 (T7) minutes after the operation. Results No statistically significant differences were found in the age, gender, weight, height, body mass index, surgery duration, and anesthetic duration (p > 0.05). There were no statistically significant differences at T1, T3, T4, T5, T6, and T7 (p > 0.007), but there was a significant difference at T2 (p < 0.001), with Groups II and III having lower pressure than Group I (p < 0.001). Conclusion The high-flow desflurane group had higher postinduction middle ear pressure values. Therefore, low-flow anesthesia and TIVA can be used more safely in middle ear surgeries, provided that a well-equipped anesthetic device and appropriate monitoring conditions are available.
Highlights
The middle ear is an air-filled lacuna, with a volume of approximately 0.5 cm, located in the temporal bone
No statistically significant differences were found among the groups in terms of the clinical and demographic features, such as age, gender, weight, height, body mass index (BMI), and surgical and anesthetic durations (p > 0.05) (Table 1)
There were no statistically significant differences among the groups according to the Bonferroni adjustment regarding the percentage changes in the systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), SpO2, and EtCO2 levels at T1, T2, T3, T4, and T7, when compared to T0 (p > 0.0033)
Summary
The middle ear is an air-filled lacuna, with a volume of approximately 0.5 cm, located in the temporal bone. Attention must be paid in choosing anesthetic agents that cause minimal intratympanic pressure increases to prevent adverse effects [1, 2], including middle ear condition changes, haemotympanum, serous otitis, temporary or permanent hearing loss, tympanic membrane graft dislocation, or deformation of the ossicular chain. Most previous investigations of the middle ear pressure (MEP) have been performed with nitrous oxide, halothane, sevoflurane, desflurane, and total intravenous anesthesia (TIVA) with propofol [5, 6]. Aim. This study compared the effects of high-flow total intravenous anesthesia (TIVA) and low- and high-flow desflurane anesthesia on middle ear pressure. In this retrospective double-blind study, 90 patients (20–65 years old) scheduled to undergo elective thyroidectomies were divided into three randomized anesthesia groups: high-flow desflurane (Group I), low-flow desflurane (Group II), and high-flow TIVA (propofol, remifentanil) (Group III). Low-flow anesthesia and TIVA can be used more safely in middle ear surgeries, provided that a well-equipped anesthetic device and appropriate monitoring conditions are available
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