Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery

Jarosław Miłoński, Hanna Zielińska-Bliźniewska, Wojciech Golusiński, Joanna Urbaniak, Rafał Sobański, Jurek Olszewski, Jarosław Miłoński, Hanna Zielińska-Bliźniewska, Wojciech Golusiński, Joanna Urbaniak, Rafał Sobański, Jurek Olszewski

Abstract

The aim of the study was to assess the effect of three different types of anaesthesia on perioperative bleeding control and to analyse the mean arterial blood pressure and heart rate in patients undergoing endoscopic paranasal sinus surgery. Ninety patients (30 women and 60 men, aged 18-85 years) scheduled to undergo functional endoscopic sinus surgery in the years 2008-2010 were identified as candidates for inclusion in the study. Patients were randomly assigned to one of three groups (30 patients each) according to the type of general anaesthesia to be administered. Groups I and II both received inhalation anaesthesia (sevoflurane for sedation) and intravenous anaesthesia (fentanyl in group I, remifentanil in group II). Anaesthesia was delivered solely via intravenous route (TIVA) in group III, with propofol used for sedation and remifentanil for analgesia. Blood pressure and heart rate were monitored during surgery and post-surgically for 4 h. Mean anaesthesia duration in groups I, II and III was 108.7 ± 20.8, 112.6 ± 22.2 and 103.7 ± 17.5 min and the surgery duration was 71.3 ± 16.7, 78.8 ± 24.2 and 66.5 ± 15.5 min, respectively. Mean blood loss during surgery was 365.0 ± 176.2, 340.0 ± 150.5 and 225.0 ± 91.7 ml, with a mean blood loss rate of 5.1 ± 2.4, 4.5 ± 2.2 and 3.4 ± 1.1 ml/min in groups I, II and III, respectively. Technologically advanced control of the drug dose with the TIVA technique allows for better control of perioperative bleeding.

Figures

Fig. 1
Fig. 1
Mean anaesthesia duration (min) in individual anaesthesia types by patient gender
Fig. 2
Fig. 2
Mean surgery duration (min) in individual anaesthesia types by patient gender
Fig. 3
Fig. 3
Mean values of blood loss (ml) in particular anaesthesia types by patient gender
Fig. 4
Fig. 4
Rate of blood loss (ml/min) in individual anaesthesia types by patient gender

References

    1. Ko MT, Chuang KC, Su CY. Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery. Laryngoscope. 2008;118:1687–1691. doi: 10.1097/MLG.0b013e31817c6b7c.
    1. Baker AR, Baker AB. Anaesthesia for endoscopic sinus surgery. Acta Anaesth Scand. 2010;54(7):795–803. doi: 10.1111/j.1399-6576.2010.02259.x.
    1. Gorce BM, Ozkose Z, Tuncer B, Pampal K, Arslan D. Hemodynamic effects, recovery profiles, and costs of remifentanyl-based anaesthesia with propofol or desfluran for septorhinoplasty. Saudi Med J. 2007;28(3):358–363.
    1. Sieśkiewicz A, Drozdowski A, Rogowski M. The assessment of correlation between mean arterial pressure and intraoperative bleeding during endoscopic sinus surgery in patients with low heart rate. Otolaryngol Pol. 2010;64(4):225–228. doi: 10.1016/S0030-6657(10)70020-2.
    1. Sivaci R, Yilmaz MD, Balci C, Erincler T, Uhul H. Comparison of propofol and sevoflurane anaesthesia by means of blood loss during endoscopic sinus surgery. Saudi Med J. 2004;25(12):1995–1998.
    1. Wormald PJ, van Renen G, Perks J, Jones JA. The effect of the total intravenous anaesthesia compared with inhalational anaesthesia on the surgical field during endoscopic sinus surgery. Am J Rhinol. 2005;19(5):514–520.
    1. Eberhart LH, Folz BJ, Wulf H, Geldner G. Intravenous anaesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery. Laryngoscope. 2003;113:1369–1373. doi: 10.1097/00005537-200308000-00019.
    1. Momota Y, Kaneda K, Arishiro K. Changes in blood pressure during induction of anaesthesia and maxillofacial surgery by type and timing of discontinuation of antihypertensive drugs. Anesth Prog. 2010;57(1):13–17. doi: 10.2344/0003-3006-57.1.13.
    1. Blackwell KE, Ross DA, Kapur P, Calcaterra TC. Propofol for maintenance of general anaesthesia: a technique to limit blood loss during endoscopic sinus surgery. Am J Otolaryngol. 1993;14:262–266. doi: 10.1016/0196-0709(93)90072-F.
    1. Ahn HJ, Chung SK, Dhong HJ, Kim HY, Ahn JH, Lee SM, Hahm TS, Kim JK. Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery. Br J Anaesth. 2008;100:50–54. doi: 10.1093/bja/aem304.
    1. Nair S, Collins M, Hung P, Rees G, Close D, Wormald PJ. The effect of β blocker premedication on the surgical field during endoscopic sinus surgery. Laryngoscope. 2004;114:1042–1046. doi: 10.1097/00005537-200406000-00016.
    1. Nekhendzy V, Lemmens HJ, Vaughan WC, Hepworth EJ, Chiu AG, Church CA, Brock-Utne JG. The effect of deliberate hypercapnia and hypocapnia on intraoperative blood loss and quality of surgical field during functional endoscopic sinus surgery. Anesth Analg. 2007;105:1404–1409. doi: 10.1213/01.ane.0000282781.56025.52.
    1. Baker AR, Baker A. Anaesthesia for endoscopic sinus surgery. Acta Anaesth Scand. 2010;54:795–803. doi: 10.1111/j.1399-6576.2010.02259.x.
    1. Cafiero T, Cavallo LM, Frangiosa A, Burrelli R, Gargiulo G, Cappabianca P, De Divitiis E. Clinical comparison of remifentanil–sevoflurane versus remifentanil–propofol for endoscopic endonasal transphenoidal surgery. Eur J Anaesth. 2007;24:441–446. doi: 10.1017/S0265021506002080.
    1. Manola M, De Luca E, Moscillo L, Mastella A. Using remifentanil and sufentanil in functional endoscopic sinus surgery to improve surgical conditions. ORL J Otorhinolaryngol Relat Spec. 2005;67:83–86. doi: 10.1159/000084576.
    1. Crawley BK, Barkdull GC, Dent S, Bishop M, Davidson TM. Relative hypotension and image guidance: tools for training in sinus surgery. Arch Otolaryngol Head Neck Surg. 2009;135:994–999. doi: 10.1001/archoto.2009.139.
    1. Danielson R, Gravningsbraten R, Olofsson J. Anaesthesia in endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2003;260:481–486. doi: 10.1007/s00405-003-0613-z.
    1. Nair S, Collins M, Huang P, et al. The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery. Laryngoscope. 2004;114:1042–1046. doi: 10.1097/00005537-200406000-00016.
    1. Simpson P. Perioperative blood loss and its reduction; the role of the anaesthetist. Brit J Anaesth. 1992;69:498–507. doi: 10.1093/bja/69.5.498.
    1. Boezzart AP, van der Merve J, Coetzee A. Comparison of sodium nitroprusside and esmolol induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth. 1995;42:373–376. doi: 10.1007/BF03015479.

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