Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol- vs Desflurane-Based Anesthesia

Otolaryngol Head Neck Surg. 2020 Oct;163(4):835-842. doi: 10.1177/0194599820921863. Epub 2020 May 26.

Abstract

Objective: To assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery.

Study design: Prospective, randomized, controlled trial.

Setting: Academic teaching hospital and Veterans Affairs hospital in the United States.

Subjects and methods: Seventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α = .05.

Results: There were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min-1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg-1 min-1; P = .01). The bleeding score correlated positively with height (P = .014) and the Lund-MacKay score (P = .013). Bilateral vs unilateral surgery led to longer surgery duration (P = .001) and recovery room time (P = .004).

Conclusion: When remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.

Keywords: FloTrac; TIVA; cardiac output; remifentanil; volatile anesthetics.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage
  • Anesthetics, General* / adverse effects
  • Blood Loss, Surgical / prevention & control*
  • Blood Loss, Surgical / statistics & numerical data
  • Blood Pressure / drug effects*
  • Desflurane* / adverse effects
  • Endoscopy / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Propofol* / adverse effects
  • Remifentanil / administration & dosage*
  • Sinusitis / surgery*

Substances

  • Analgesics, Opioid
  • Anesthetics, General
  • Desflurane
  • Remifentanil
  • Propofol