Effects of Total Intravenous Anesthesia vs Inhalational Anesthesia in Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Randomized Controlled Study

Abstract

Objective: Compare anesthesia with sevoflurane/remifentanyl (SR) to total intravenous anesthesia with propofol/remifentanyl (PR) in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis in the following parameters: 1) effects on blood flow to the mucosa; 2) amount of blood loss; and 3) surgical field visualization score (SFS). Method: A total of 23 adults undergoing endoscopic sinus surgery for chronic rhinosinusitis within a 6-month period were randomized to receive SR or PR. The SFS was based on the Boezaart scale. Sinonasal mucosa blood flow was measured by optical rhinometry (OR). Blood loss was recovered with the Neptune Waste Management System. Results: The groups were evenly distributed, with similar clinical characteristics and Lund-Mackay score. Median blood loss was 105 cc in the PR group and 180 cc in the SR group ( P = .15). The length of surgery was 134 minutes in the PR group and 177 minutes in the SR group ( P = .19). The average SFS was 1.6 in the PR group and 2.0 in the SR group ( P = .22). OR showed a decrease in blood flow to -0.1 OR units from the beginning of surgery in the PR group compared with -0.4 OR units in the SR group ( P = .02). Conclusion: Our preliminary results suggest that PR appears to be associated clinically to a decreased blood loss, improved surgical field visualization, and decreased operative time in endoscopic sinus surgery. We showed however that blood flow to the nasal cavity appears to be increased with TIVA.