Variations in S-100Β and Neuron-Specific Enolase Levels During Functional Endoscopic Sinus Surgery Under Moderately...

Area of Science:

• Anesthesiology
• Neurosurgery
• Neuroscience

Background:

• Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical visibility but risks cerebral hypoperfusion.
• Serum biomarkers S100B (glial injury) and NSE (neuronal injury) can indicate perioperative neuroprotection.
• Different anesthetic regimens may impact these neuroprotective markers.

Purpose of the Study:

• To evaluate the effect of four anesthetic protocols on perioperative brain biomarker release during FESS.
• To compare S100B and NSE concentrations across different anesthetic regimens under controlled hypotension.
• To assess the neurobiological impact of anesthetic choices during FESS.

Main Methods:

• A single-center, randomized controlled trial involving 88 adult patients undergoing FESS.
• Patients were allocated to four groups: propofol-remifentanil, propofol-remifentanil with ketamine-magnesium, sevoflurane-remifentanil, or sevoflurane-remifentanil with ketamine-magnesium.
• Serum S100B and NSE levels were measured at three intraoperative timepoints; data analyzed using nested ANOVA and linear mixed-effects models.

Main Results:

• Sevoflurane-remifentanil with ketamine-magnesium showed the lowest S100B levels.
• Both sevoflurane-based groups exhibited significantly lower NSE concentrations compared to propofol-remifentanil.
• No significant differences in surgical field quality, bleeding, or hemodynamics were observed; propofol-based anesthesia resulted in faster recovery.

Conclusions:

• Anesthetic technique significantly influences perioperative brain biomarker release during FESS.
• Sevoflurane-based anesthesia, with or without ketamine-magnesium, offers a more favorable neurobiological profile under controlled hypotension.
• While propofol-based anesthesia promotes faster recovery, sevoflurane-based regimens appear to provide better neuroprotection.