Blood Loss During Endoscopic Sinus Surgery With Propofol or Sevoflurane

Chaaban, Mohamad R.; Baroody, Fuad M.; Gottlieb, Ori; Naclerio, Robert M.

doi:10.1001/jamaoto.2013.2885

Cited by 35 publications

(48 citation statements)

References 24 publications

(32 reference statements)

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“…Surgical visibility was graded in included studies via either a 10‐point grading system (Wormald scale, VAS) or a 5‐point grading scale (Boezaart score) in which the higher the score, the poorer the visibility of the surgical field. Pooled analysis from four RCTs of the 10‐point VAS for surgical visibility demonstrated significantly lower scores for the TIVA group compared to IA (WMD −1.06, 95% CI −2.11, −0.01, I 2 = 96%, P = 0.049) (Fig. A).…”

Section: Resultsmentioning

confidence: 98%

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Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Phan

2019

The Laryngoscope

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Objective Achieving optimal intraoperative surgical field visibility and minimizing blood loss are two important parameters in endoscopic sinus surgery (ESS). The aim of this meta‐analysis was to compare two total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) to determine if either conferred superior outcomes of these and other parameters based on randomized control trials (RCTs) only. Methods The recommended Preferred Reporting Items for Systematic reviews and Meta‐Analyses guidelines were followed, and searches of electronic databases from inception to September 2018 identified 157 articles for screening. Data were extracted and analyzed using meta‐analysis of proportions. Results In total, we identified 15 RCTs that satisfied our selection criteria. There were 828 ESS cases described, with 391 (47%) and 437 (53%) being managed by TIVA and IA, respectively. Pooled analysis demonstrated significantly superior visibility scores for TIVA compared to IA based on 10‐point grading scores (P = 0.049, visual analog scale; P = 0.009, Wormald scale) and 5‐point grading scores (P = 0.002, Boezaart scale). Blood loss was significantly less following TIVA (P = 0.003), with no significant difference in intraoperative heart rate (P = 0.70) or mean arterial pressure (P = 0.96). Additionally, duration of surgery (P = 0.16) and anesthesia (P = 0.39) were comparable between the two approaches. Conclusion This meta‐analysis indicates that TIVA has the potential to confer superior surgical field visibility and reduce intraoperative blood loss compared to IA in ESS. Currently, there are significant heterogeneity concerns in this meta‐analysis, which temper any expectations that either approach is absolutely superior to the other. Caution should be exercised when interpreting these results until further validation can be achieved. Level of Evidence 1A Laryngoscope, 130:575–583, 2020

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Section: Resultsmentioning

confidence: 98%

“…Screening identified 38 articles for full‐text evaluation. After applying the selection criteria, 15 RCTs comparing TIVA to IA agents were selected for analysis (Fig. ).…”

Section: Resultsmentioning

confidence: 99%

Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Phan

2019

The Laryngoscope

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“…6,13 Studies in vitro suggest that sevoflurane inhibits ADP-induced platelet aggregation, but not thrombin- or collagen-induced aggregation. 31 This may also help explain why blood loss after endoscopic sinus surgery was similar for patients anesthetized with inhaled sevoflurane or with intravenous propofol. 30 …”

Section: Discussionmentioning

confidence: 99%

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery

et al. 2016

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Patients undergoing cardiac surgery often experience abnormal bleeding, due primarily to cardiopulmonary bypass (CPB)-induced activation of platelets. Sevoflurane may inhibit platelet activation, raising the possibility that administering it during CPB may reduce blood loss.Patients between 18 and 65 years old who were scheduled for cardiac surgery under CPB at our hospital were prospectively enrolled and randomized to receive intravenous anesthetics alone (control group, n = 77) or together with sevoflurane (0.5–1.0 vol/%) from an oxygenator (sevoflurane group, n = 76). The primary outcome was postoperative blood loss, the secondary outcome was postoperative need for blood products.Volume of blood loss was 48% lower in the sevoflurane group than the control group at 4 hours after surgery, and 33% lower at 12 hours after surgery. Significantly fewer patients in the sevoflurane group lost >700 mL blood within 24 hours (9 of 76 vs 28 of 77, P < 0.001). As a result, the sevoflurane group received significantly smaller volumes of packed red blood cells (1.25 ± 2.36 vs 2.23 ± 3.75 units, P = 0.011) and fresh frozen plasma (97 ± 237 vs 236 ± 344 mL, P = 0.004). Thus the sevoflurane group was at significantly lower risk of requiring complex blood products after surgery (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.17–0.68, P = 0.002).Sevoflurane inhalation from an oxygenator during CPB may reduce blood loss and need for blood products after cardiac surgery.

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“…In 2013, a prospective, randomized study of 33 patients by Chabaan et al (level 1b) calculated the mean blood loss per hour during ESS in 18 patients receiving TIVA with propofol and 15 patients receiving IA with sevoflurane. The patients' MAP was maintained at 70 to 80 mm Hg in both groups.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Methods of calculating EBL vary between studies, but usually involve subtracting the volume of irrigation used from the total volume in the suction canisters . To obtain the blood loss rate the EBL is divided by surgical time in hours …”

Section: Introductionmentioning

confidence: 99%

Does total intravenous anesthesia provide significant blood loss reduction compared to inhalational anesthesia during endoscopic sinus surgery?

2016

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Blood Loss During Endoscopic Sinus Surgery With Propofol or Sevoflurane

Abstract: In this comparative study, our results did not show any difference in blood loss and surgical conditions between the TIVA and IA groups. Even further study is not likely to show a difference in blood loss between TIVA and IA during ESS.

Cited by 35 publications

References 24 publications

Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta‐analysis

Low-Dose Sevoflurane May Reduce Blood Loss and Need for Blood Products After Cardiac Surgery

Does total intravenous anesthesia provide significant blood loss reduction compared to inhalational anesthesia during endoscopic sinus surgery?

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