Surgical Field Visualization during Functional Endoscopic Sinus Surgery: Comparison of Propofol- vs Desflurane-Based Anesthesia.

Autor: Gollapudy S; Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Gashkoff DA; Medical School, Medical College of Wisconsin, Milwaukee, Wisconsin, USA., Poetker DM; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA., Loehrl TA; Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Department of Surgery, Division of ENT, Clement J. Zablocki VA Medical Center, Milwaukee, Wisconsin, USA., Riess ML; Anesthesiology, TVHS VA Medical Center, Nashville, Tennessee, USA.; Departments of Anesthesiology and Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2020 Oct; Vol. 163 (4), pp. 835-842. Date of Electronic Publication: 2020 May 26.
DOI: 10.1177/0194599820921863
Abstrakt: 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.
Databáze: MEDLINE
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