Faculty Collaboration Database

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

Date

05/27/2020

Pubmed ID

32450733

Pubmed Central ID

PMC8500338

DOI

10.1177/0194599820921863

Scopus ID

2-s2.0-85085396175 (requires institutional sign-in at Scopus site)   8 Citations

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.

Author List

Gollapudy S, Gashkoff DA, Poetker DM, Loehrl TA, Riess ML

Authors

Suneeta Gollapudy MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
David M. Poetker MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Analgesics, Opioid
Anesthetics, General
Blood Loss, Surgical
Blood Pressure
Endoscopy
Female
Humans
Male
Middle Aged
Propofol
Sinusitis