Propofol versus isoflurane for endoscopic sinus surgery

A previous retrospective study reported that propofol anesthesia decreased bleeding during endoscopic sinus surgery compared with isoflurane. We performed a prospective study to compare the effects of propofol versus isoflurane on measured blood loss and the surgeon's subjective assessment of operating conditions during endoscopic sinus surgery.

After receiving institutional review board approval and written informed consent, 56 patients undergoing endoscopic sinus surgery were randomly assigned to receive propofol (n = 30) or isoflurane (n = 26) supplemented with nitrous oxide-oxygen and alfentanil. Blood loss was calculated from the hemoglobin concentration in suction canisters. One surgeon, who was blinded to the anesthetic agent, performed every procedure and assessed bleeding as follows: 1, no bleeding; 2, modest bleeding; 3, bleeding interfering with operating conditions and cause for an agent switch; and 4, intolerable bleeding requiring a change in surgical plan. Results were compared in the two anesthetic groups using chi-squared test, unpaired t-test, Mann-Whitney Utest, and a permutation test. A P of .05 was considered significant.

Mean bleeding scores were less over time (P = .02) with propofol anesthesia, particularly in surgery in the ethmoid and sphenoid sinuses (P = .03), and the proportion of patients with a mean score >2 was less in the propofol group (30% v 54%; P = .033). Time until discharge to home or to a limited stay in a hospital bed was also less in the propofol group (183 v 243 minutes; P = .019).

In our study, surgical blood loss was the same for both anesthetic agents overall, but propofol appeared to offer an advantage in terms of subjective improvement in operating conditions, particularly in the ethmoid and sphenoid sinuses.