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

Al-Bar, Mohammad H.; Ruiz, Jose W.; Casiano, Roy R.

doi:10.1002/lary.25900

Cited by 9 publications

(17 citation statements)

References 5 publications

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“…Furthermore, the significantly reduced blood loss following TIVA compared to IA reflects the general trend of noninferior, or perhaps superior, hemodynamic control by TIVA. The statistical significance of this finding is important because previous results in the literature may be limited by statistical power …”

Section: Discussionmentioning

confidence: 64%

“…The statistical significance of this finding is important because previous results in the literature may be limited by statistical power. 4,8,28 A potential cause for the great variance between individual studies may be a result of different extents of controlling by studies for possible confounding factors affecting our reported parameters. The LM score is a radiologic complexity measure of chronic rhinosinusitis, which has been shown to correlate with intraoperative complication rates.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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

Phan

2019

The Laryngoscope

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“…15,17,21 Although several studies have concluded that TIVA may improve surgical conditions during the endoscopic sinus surgery, 12,13,22–24 others could not show a difference, 2526–28 and more so, those that did, often had severe limitations in design and/or power to preclude an overall recommendation. 10,14,15 Caution is also warranted because different agents are used in TIVA at different combinations and infusion rates; the same is true for different InhA regimen. Moreover, studies are rarely controlled for the effect of the anesthetic regimen on blood pressure or its determinants cardiac output and systemic vascular resistance.…”

Section: Discussionmentioning

confidence: 99%

“…29–31 Other factors, such as nasal polyposis, degree of inflammatory disease, positioning of the patient, irrigation, topical decongestion, and injection of vasoconstrictors, that may play an important role for blood loss, may not have been strictly controlled in these studies, either. 15 …”

Section: Discussionmentioning

confidence: 99%

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

Gollapudy

Poetker

Sidhu

et al. 2018

American Journal of Otolaryngology

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“…Previous comparative studies of inhalational anesthesia and TIVA techniques for ESS have primarily focused on outcomes of ESS such as blood loss and cardiovascular parameters, rather than the factors that influence decision making to the choice of anesthetic. 7,9,14 This survey is the first to investigate the opinions of anesthesia providers at various levels of training and geographic locations on inhalational anesthesia and TIVA for ESS with regard to practice patterns, recognition of clinical evidence, procedural comfort, and training satisfaction. We found that many providers (1) do not routinely manage high volumes of ESS cases, (2) are unfamiliar with TIVA literature for ESS, and (3) are open to further learning.…”

Section: Discussionmentioning

confidence: 99%

Survey of anesthesiologists on anesthetic maintenance techniques and total intravenous anesthesia for endoscopic sinus surgery

Yoshiyasu

Lao

Schechtman

et al. 2019

Int Forum Allergy Rhinol

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Background Inhalational anesthesia and total intravenous anesthesia (TIVA) are techniques used for maintenance of general anesthesia for endoscopic sinus surgery (ESS). Growing evidence exists that TIVA may be associated with decreased bleeding and improved surgical fields, yet data suggest it is used in a minority of sinus surgery cases. The objective of this study was to investigate perceptions and approaches to anesthetic maintenance techniques in ESS among anesthesia providers. Methods A total of 719 anesthesiology residents, faculty, and certified registered nurse anesthetists (CRNAs) at 3 tertiary academic centers in the United States were invited to participate in a survey of considerations and practice patterns for inhalational anesthesia and TIVA for ESS. Results Responses were received from 200 participants (28%). Sixty‐five percent of respondents reported a lack of familiarity with current literature on TIVA for ESS. Many considered factors other than surgical field visualization when choosing a maintenance technique. Most were comfortable with performing TIVA but stated they would participate in additional training. Conclusion The majority of anesthesiology providers were unaware of the existing literature demonstrating advantage in improved surgical visualization with TIVA. Many used a combination of inhaled and intravenous anesthetics for maintenance. These findings suggest that future opportunities may exist to develop education, training, and practice approaches specific to anesthetic techniques for ESS.

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

Cited by 9 publications

References 5 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

Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery

Survey of anesthesiologists on anesthetic maintenance techniques and total intravenous anesthesia for endoscopic sinus surgery

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