Propofol for maintenance of general anesthesia: A technique to limit blood loss during endoscopic sinus surgery

Abstract

Purpose: Most cases of endoscopic sinus surgery are amenable to techniques using local anesthesia with monitored sedation. However, it is frequently the preference of the patient to have surgery under general anesthesia. One major drawback of general anesthesia is the increased bleeding encountered which can interfere with optimal visualization of the intranasal anatomy. In this study, an analysis was made to see if technique of general anesthesia has an impact on estimated blood loss in patients undergoing endoscopic sinus surgery. Methods: Twenty-five patients undergoing outpatient endoscopic sinus surgery under general anesthesia over a 1-year period were reviewed retrospectively to determine if anesthetic technique had an impact on estimated blood loss. Twelve patients were identified who received a continuous intravenous infusion of the nonbarbituate hypnotic agent propofol as the primary anesthetic agent, and 13 patients were identified who received anesthesia based on inhalational isoflurane. Results: There was no difference between the duration of surgery or the intraoperative mean arterial blood pressure when comparing the two groups. The average estimated blood loss in the propofol group was 101 mL compared with an average estimated blood loss of 251 mL in the isoflurane group ( P < .01). Conclusions: General anesthesia based on propofol infusion may have the advantage of decreased bleeding compared with conventional inhalation agents, making endoscopic sinus surgery technically easier and safer by improving endoscopic visualization of the surgical field. This anesthetic technique may have other applications in otolaryngology, where bleeding within a confined space frequently can interfere with visibility.