Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial

Brunner, Jacob P.; Levy, Joshua M.; Ada, Melissa L.; Tipirneni, Kiranya E.; Barham, Henry P.; Oakley, Gretchen M.; Cox, Daniel; Nossaman, Bobby D.; McCoul, Edward D.

doi:10.1002/alr.22173

Cited by 40 publications

(58 citation statements)

References 29 publications

(30 reference statements)

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“…Duration of surgery was similar among the TIVA and IA groups (WMD −3.31, 95% CI −7.95, 1.34, I 2 = 69%, P = 0.16) based on 13 RCTs (Fig. A).…”

Section: Resultsmentioning

confidence: 88%

“…A). Pooled analysis from two RCTs of the 10‐point Wormald scale for surgical visibility also demonstrated significantly lower scores for the TIVA group compared to IA (WMD −0.73, 95% CI −1.28, −0.19, I 2 = 30%, P = 0.009) (Fig. A).…”

Section: Resultsmentioning

confidence: 93%

“…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%

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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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“…Duration of surgery was similar among the TIVA and IA groups (WMD −3.31, 95% CI −7.95, 1.34, I 2 = 69%, P = 0.16) based on 13 RCTs (Fig. A).…”

Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 93%

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

Phan

2019

The Laryngoscope

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“…Numerous techniques have been applied to minimize blood loss and improve endoscopic visualization during ESS, including the reverse Trendelenburg position and total intravenous anesthesia (TIVA). In addition, numerous medications have been used to improve hemostasis during surgery including topical 1:1000 epinephrine and infiltration with lidocaine with 1:100,000 epinepherine …”

Section: Wormald Surgical Field Grading Scalementioning

confidence: 99%

“…In addition, numerous medications have been used to improve hemostasis during surgery including topical 1:1000 epinephrine and infiltration with lidocaine with 1:100,000 epinepherine. [1][2][3][4][5] Numerous studies have demonstrated the efficacy and safety of topical 1:1000 epinephrine in preparation of ESS. [6][7][8] Traditional teaching has also advocated for the local infiltration of lidocaine with 1:100,000 epinephrine in an effort to diminish blood loss and improve endoscopic 6 10 points of ooze, obscuring surface (sphenoid fills in 50 seconds) 7 Mild bleeding/oozing from entire surgical surface with slow accumulation of blood in the postnasal space (sphenoid fills by 40 seconds) 8 Moderate bleeding from entire surgical surface with moderate accumulation of blood in postnasal space (sphenoid fills by 30 seconds) 9 Moderately severe bleeding with rapid accumulation of blood in the postnasal space (sphenoid fills by 20 seconds) 10 Severe bleeding with nasal cavity filling rapidly (sphenoid fills in <10 seconds)…”

mentioning

confidence: 99%

The effect of topical epinephrine 1:1000 with and without infiltration of 1% lidocaine with epinephrine 1:100,000 on endoscopic surgical field visualization: a double‐blind randomized controlled study

Tangbumrungtham

Hwang

Maul

et al. 2019

Int Forum Allergy Rhinol

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Background The objective of this study is to determine whether the infiltration of 1% lidocaine with 1:100,000 epinephrine in addition to topical application of 1:1000 epinephrine significantly improves surgical field grading scale score over topical 1:1000 epinephrine alone. Methods A prospective, double‐blind, randomized, controlled study was performed of 40 patients undergoing bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS). Patients were enrolled and randomly assigned to receive infiltration with 1% lidocaine with 1:100,000 epinephrine on 1 side of the nasal cavity vs plain saline on the other side in preparation for ESS. Both groups received topical application of 1:1000 epinephrine. Surgical videos were recorded and Wormald surgical field grading scale was assigned by 2 blinded reviewers. The number of extra 1:1000 epinephrine pledgets used during the surgery, estimated blood loss, and surgical duration were also recorded. Results There were no statistically significant differences in Wormald surgical field grading scale, number of extra pledgets used, or estimated blood loss between the nasal cavity side infiltrated with 1% lidocaine with 1:100,000 epinephrine in comparison to infiltration with saline. The side infiltrated with 1% lidocaine with 1:100,000 epinephrine had a reduced operative time compared to the side infiltrated with saline (p = 0.002). There were no differences in postoperative bleeding from questionnaire completed by patient at the first postoperative visit. Conclusion Addition of infiltration of 1% lidocaine with epinephrine 1:100,000 to topical application of epinephrine 1:1000 for preparation of ESS does not significantly improve surgical field of view compared to topical epinephrine alone.

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Moving slowly but surely toward more precise rhinologic care

Hwang¹

2018

Int Forum Allergy Rhinol

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Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial

Abstract: TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high-grade inflammatory sinus disease.

Cited by 40 publications

References 29 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

The effect of topical epinephrine 1:1000 with and without infiltration of 1% lidocaine with epinephrine 1:100,000 on endoscopic surgical field visualization: a double‐blind randomized controlled study

Moving slowly but surely toward more precise rhinologic care

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