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Total intravenous anaesthesia in endoscopic sinus-nasal surgery
G Tirelli1, S Bigarini, M Russolo
1Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, University of Trieste, Italy. tirellig@units.it
Summary
Total intravenous anesthesia with remifentanil and propofol effectively reduced bleeding during endoscopic sinus surgery compared to inhaled anesthesia. Both anesthesia types achieved controlled hypotension, but only TIVA significantly improved surgical bleeding control.
Area of Science:
- Anesthesiology
- Otolaryngology
- Surgical Hemorrhage Control
Background:
- Functional endoscopic sinus surgery (FESS) requires optimal surgical field visualization.
- Controlled hypotension is a technique used to reduce intraoperative bleeding.
- Comparing anesthetic techniques for their efficacy in FESS is crucial.
Purpose of the Study:
- To compare the effectiveness of total intravenous anesthesia (TIVA) with remifentanil and propofol versus inhaled anesthesia with isoflurane and fentanyl in controlling bleeding during FESS.
- To evaluate the impact of these anesthetic techniques on hemodynamic parameters and patient safety.
Main Methods:
- A randomized study involving 64 patients undergoing FESS.
- Two anesthesia groups: TIVA (remifentanil/propofol) and inhaled (isoflurane/fentanyl).
- Monitoring of arterial pressure, heart rate, PetCO2, and SpO2. Bleeding assessed using the Fromme-Boezaart scale.
Main Results:
- Both anesthetic techniques effectively reduced arterial pressure, achieving target hypotension (60-70 mmHg).
- TIVA resulted in significantly lower systolic arterial pressure at 15 minutes compared to inhaled anesthesia (p=0.02).
- Only TIVA demonstrated a significant reduction in bleeding during FESS.
Conclusions:
- TIVA and inhaled anesthesia are equally effective in achieving controlled hypotension for FESS.
- Total intravenous anesthesia offers a significant advantage in reducing intraoperative bleeding during FESS.