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Does total intravenous anesthesia provide significant blood loss reduction compared to inhalational anesthesia during endoscopic sinus surgery?
Author(s) -
AlBar Mohammad H.,
Ruiz Jose W.,
Casiano Roy R.
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25900
Subject(s) - medicine , anesthesia , isoflurane , remifentanil , propofol , blood loss , fentanyl , blood pressure , blood volume , surgery , heart rate , sevoflurane , radiology
BACKGROUND Total intravenous anesthesia (TIVA) is defined as induction and maintenance of general anesthesia using solely intravenous agents, which usually includes propofol and a short-acting opiate (e.g., fentanyl or remifentanil). Traditional inhalational anesthesia (IA) is maintenance of general anesthesia using inhalation agents (e.g., isoflurane or sevoflurane). Several studies have tried to assess the impact of TIVA in endoscopic sinus surgery (ESS) by evaluating the surgical field visibility score, mean arterial pressure, heart rate, operative time, and blood loss. Although some studies show TIVA reduces surgical blood loss when compared to traditional IA, other studies have shown no difference in blood loss. In our review, we will focus on the relationship between TIVA and intraoperative blood loss in ESS. Accurate measurements of estimated blood loss (EBL) in sinus surgery are difficult because of copious irrigation, blood lost to ingestion, and blood outside the surgical field. Furthermore, surgical time can affect EBL, such that blood loss at a constant rate would yield higher EBL for longer cases. To account for this, some studies calculate blood loss as a rate, yielding outcomes in blood loss per hour. 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.

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