Controlled Hypotension Using Remifentanil/Propofol Intravenous Anesthesia Reduces Bleeding and Improves Outcome of Functional Endoscopic Sinus Surgery
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This study was designed to improve the control of bleeding during functional endoscopic sinus surgery (FESS) using controlled hypotension achieved through either total intravenous anesthesia (TIVA) using rernifentanil and propofol (RFMI/PRO), or inhaled anesthesia (INN) using isoflurane and fentanyl (ISO/FEN). Patients & Methods: This study included 40 patients into two groups (n=20): TIVA group and INN group, anesthesia was induced by a bolus of RENZI (1 pg//kg) followed by PRO (1-2 mg/kg) in TIVA group and using PRO (1-2 mg/kg) and FEN (2 pelcg) in INN group and was maintained in TWA group by slow infusion of 2 mg of REMI in 40 cc saline and 50 cc of PRO and in INN group, anesthesia was maintained with ISO 1-2% with infusion of TIVA and MAC of isoflurane were adapted until reaching pressure of 60-70 mmHg. Patients underwent packing of the cavity with adrenaline soaked pledgets (1:1000) that were removed after 5 minutes. The two groups were monitored non-invasively; before induction of anesthesia (TO, 15 (Ti) and 30 minutes (TO after induction of anesthesia, for systolic (SAP), diastolic (DAP), and mean arterial pressure; heart rate (HR) and SPcn. The visibility of the operative field during FESS was evaluated using Fromme-Boezzart Scale. Results: Both modalities of anesthesia reduced blood pressure significantly (P<0.05) at Ti and 12 compared to preoperative pressure, moreover, blood pressure parameters showed progressive significant (P<0.05) decrease at 12 compared to measures determined at 77. Systolic blood pressure was significantly (P<0.05) while DAP was non-significantly (P>0.05) decreased, at both T1 and 22, in INN group compared to TWA group and MAP was non-significantly (P>0.05) decreased at 77 and significantly (P<0.05) decreased at 72 in INN group compared to TIVA group. Mean HR showed progressive decrease in both TWA and INN groups at T1 and T2 compared to their preoperative rates; with a non-significant difference between both groups. Patients included in TWA groups had a significantly (P<0.05) less amount and score of bleeding compared to INN group with a positive significant correlation between the score of bleeding and MAP estimated at 72 in TWA and INN groups. Conclusion: controlled hypotension achieved using TIVA could minimize bleeding, improves field visibility and thus the outcome of FESS.