Total intravenous anaesthesia versus volatile induction and maintenance anaesthesia for controlled hypotension in lumbar spine fixation surgery: Comparative clinical study

Abstract

Background: Controlled hypotension during general anesthesia aims to lower the mean arterial blood pressure (MAP)to values between 55 and 65 mmHg in patients with normal blood pressure, with the goal of significantly reducing blood loss by maintaining it at this level throughout the operation process. Controlled hypotension is frequently used for obtaining better exposure during spine surgery as small bleeding areas can produce better surgical field visibility and result in decreased time of surgery.Objective: This study was done to compare the efficacy and safety of TIVA and VIMA to induce hypotensive technique during spine surgery, with attention on the amount of blood loss, blood transfusion, hemodynamics, time of recovery and postoperative nausea and vomiting. Patients and Methods: This study included 40 patients of both sex, admitted for lumbar spine fixation surgery carried out at Al- Azhar University Hospitals (El-Hussein and Bab El-Sharia). They were randomly allocated into two equal groups, 20 patients each (n= 20): Group I (TIVA); Total intravenous anaesthesia using (fentanyl and propofol). Group II (VIMA); Volatile induction and maintenance anesthesia (Inhalational anaesthesia) using (fentanyl and sevoflurane). Results: The following parameters were assessed between the 2 groups: Hemodynamics (HR, SBP, DBP and MAP), SPO2 and ET CO2 were continuously monitored and recorded at 15 min interval. Intraoperative blood loss, blood transfusion, duration of surgery, time of recovery and postoperative nausea and vomiting were monitored in all patients. Conclusion: this study showed that both TIVA and VIMA were effective in producing controlled hypotension for lumbar spinal fixation surgery. However, only TIVA was beneficial, allowing properly controlled hypotension, minimized intraoperative bleeding, and improved surgical field visibility compared to VIMA.