Total intravenous anaesthesia versus inhaled anaesthesia for endoscopic sinus surgery: a meta-analysis of randomized controlled trials.

Abstract

Total intravenous anaesthesia (TIVA) with propofol, compared to inhaled anaesthesia (IA), has been proposed to reduce bleeding and improve surgical field quality during endoscopic sinus surgery (ESS), but prior meta-analyses have not been conclusive. We performed an updated meta-analysis to determine the benefit of TIVA versus IA during ESS. PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCTs) comparing TIVA versus IA. Demographic and outcome data were extracted from articles meeting selection criteria and analysed. We included 12 RCTs for a total of 560 patients. Preoperative characteristics were similar between the two groups. Compared to IA, TIVA improved surgical visibility, estimated blood loss (EBL), and operative time. In a subgroup analysis with remifentanil as the short-acting opioid, TIVA improved surgical visibility, EBL, and operative time. These benefits were not seen with fentanyl as the short-acting opioid. TIVA with propofol, in comparison to IA, may improve surgical field quality, reduce blood loss, and decrease operative time for ESS. Remifentanil is the preferred short-acting opioid for TIVA in ESS.