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

Abstract

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

Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

“…The rate of blood loss can be perceived as an indirect measure of intraoperative visibility and may be a better variable than estimated blood loss when mucosal bleeding is being assessed as opposed to intraoperative arterial bleeding. Furthermore, our study examined intraoperative visibility by stratifying Boezaart, Wormald, and VAS scores which was not done by the study conducted by Kolia et al 5 Lastly, our subgroup analysis with remifentanil compared to other opioid agents adds more value to our study which is similar to Kolia et al 5 but unlike Lu et al 6 This meta-analysis demonstrates significant difference exists between TIVA and IA in regard to the rate of blood loss as well as EBL, which is consistent with findings found by the two previous meta-analyses. 5,6 Endoscopic intraoperative visibility with combined scoring systems showed that TIVA had a statistically significant improvement in intraoperative surgical field rating similar to the findings by Kolia et al 5 Wormald score were also significantly better for TIVA when compared to IA, similar to the findings of Lu et al, 6 but no significant differences were found in VAS or Boezaart scores, which contradicts the findings of the previous metaanalysis.…”

“…Two recent meta-analyses have examined sinus endoscopic visibility, EBL, and operative time as their outcomes and the authors concluded that TIVA was significantly better than IA in all outcomes. 5,6 Our meta-analysis acquired a greater number of studies and evaluated other variables such as the rate of blood loss. The rate of blood loss can be perceived as an indirect measure of intraoperative visibility and may be a better variable than estimated blood loss when mucosal bleeding is being assessed as opposed to intraoperative arterial bleeding.…”

“…Recent systematic reviews and meta-analyses have looked at the difference between TIVA and IA as well, however, they came with limitations. After reviewing the 2 most recent analyses, 5,6 we noticed missing studies that could have been included in either meta-analysis. Neither study evaluated the rate of blood loss.…”

Enfrentamiento de pacientes Testigo de Jehová en cirugía otorrinolaringológica: A propósito de un caso de resección de tumor rinosinusal

“…El sistema de recuperación de sangre autóloga es un método que permite recolectar, procesar y reinfundir la sangre perdida durante las cirugías, el cual es aceptado la mayoría de las veces por los pacientes Testigos de Jehová, especialmente cuando éste se encuentra en un circuito continuo con la circulación del paciente [12][13][14] . El uso de la anestesia total intravenosa (total intravenous anesthesia o TIVA) comparada con la anestesia inhalatoria también ha demostrado que podría ser útil en disminuir el sangrado intraoperatorio y mejorar el campo quirúrgico en cirugías endoscópicas rinosinusales, sin embargo, faltan estudios que justifiquen su beneficio frente a otras técnicas anestésicas 15 . Con respecto a todas estas opciones previamente descritas, resulta importante que sean expuestas al paciente, para que de este modo se llegue a un acuerdo de cuáles serán utilizadas.…”

The efficacy of computer-assisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: a randomized controlled trial

“…The studies on controlled hypotension and reducing intraoperative bleeding are mainly focused on the comparison of total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) (Lu et al 2020 ) and the use of drugs (Chhabra et al 2020 ). To minimize the adverse reaction, using properly non-invasive and non-pharmaceutical healing techniques may be an additional approach.…”