Total intravenous anaesthesia in endoscopic sinus-nasal surgery

Aim of this randomized study (64 patients) was to improve the control of bleeding during functional endoscopic sinusal surgery by means of controlled hypotension achieved through either total intravenous anaesthesia using remifentanyl and propofol (27 patients), or inhaled using isoflurane and fentanyl (37 patients). The following parameters were monitored before administration of anaesthesia (T0), then after 15 (T1), and 30 minutes (T2): systolic, diastolic, and mean arterial pressure; heart rate; concentration of tele-exhaled carbon dioxide (PetCO2) and percentage of peripheral saturation of haemoglobin (SPO2); bleeding according to the Fromme-Boezaart scale at T2. Mean arterial pressure values were maintained between 60-70 mmHg throughout surgery. At T0, systolic arterial pressure, diastolic arterial pressure and mean arterial pressure values were seen to overlap in the two groups. Both types of anaesthesia were effective in reducing the pressure values of T0-T1 and T1-T2 trends (p<0.0001). Systolic arterial pressure at T1 is lower with total intravenous anaesthesia compared to isoflurane and fentanyl (p=0.02). PetCO2 and heart rate show a decreasing trend independently of the type of anaesthesia employed. In conclusion, the hypotensive effect of total intravenous anaesthesia and of isoflurane and fentanyl is equivalent, but only total intravenous anaesthesia is effective in reducing bleeding during functional endoscopic sinusal surgery.