Effects of three different types of anaesthesia on perioperative bleeding control in functional endoscopic sinus surgery

The aim of the study was to assess the effect of three different types of anaesthesia on perioperative bleeding control and to analyse the mean arterial blood pressure and heart rate in patients undergoing endoscopic paranasal sinus surgery. Ninety patients (30 women and 60 men, aged 18–85 years) scheduled to undergo functional endoscopic sinus surgery in the years 2008–2010 were identified as candidates for inclusion in the study. Patients were randomly assigned to one of three groups (30 patients each) according to the type of general anaesthesia to be administered. Groups I and II both received inhalation anaesthesia (sevoflurane for sedation) and intravenous anaesthesia (fentanyl in group I, remifentanil in group II). Anaesthesia was delivered solely via intravenous route (TIVA) in group III, with propofol used for sedation and remifentanil for analgesia. Blood pressure and heart rate were monitored during surgery and post-surgically for 4 h. Mean anaesthesia duration in groups I, II and III was 108.7 ± 20.8, 112.6 ± 22.2 and 103.7 ± 17.5 min and the surgery duration was 71.3 ± 16.7, 78.8 ± 24.2 and 66.5 ± 15.5 min, respectively. Mean blood loss during surgery was 365.0 ± 176.2, 340.0 ± 150.5 and 225.0 ± 91.7 ml, with a mean blood loss rate of 5.1 ± 2.4, 4.5 ± 2.2 and 3.4 ± 1.1 ml/min in groups I, II and III, respectively. Technologically advanced control of the drug dose with the TIVA technique allows for better control of perioperative bleeding.

[The comparison of the influence of various types of anaesthesia on perioperative bleeding control in endoscopic paranasal sinus surgery]

INTRODUCTION

The study aimed at evaluating the influence of targeted hypotension with three types of anaesthetics on the amount of blood loss in extensive endoscopic operations of polyps of the nose and paranasal sinuses.

MATERIAL AND METHODS

Ninety patients, including 30 women aged 31-73 and 60 men aged 21-79, who were operated within the period of 2008-2010 at Department of Otolaryngology and Laryngological Oncology Military Medical Academy University Clinical Hospital in Lodz, were qualified for the study. The bilateral removal of nasal polyps, bilateral ethmoidectomy, and surgery or revision of the maxillary, sphenoid and temporal sinuses in endoscopy were conducted in each patient. Due to the type of general anaesthesia the patients were divided into three groups, 30 patients each: I – sevoflurane inhalation (sedation) and fentanyl I.V., II – sevoflurane inhalation (sedation) and remifentanil I.V. (analgesia), III – TIVA, propofol sedation and remifentanil analgesia. The drugs were administered via the infusion pomp TCI.

RESULTS

In group I the mean anaesthesia time was 108.67±20.80 min., group II – 112.63±22.17 min., group III – 103.67±17.47 min. The surgery time in the studied groups was as follows: I – 71.33±16.71 min, II – 78.83±24.24 min, III – 66.5±15.49 min. During the operation the mean blood loss was: group I – 365±176.2 ml, group II – 340±150.5 ml, group III – 225±91.7 ml. During the operation the mean rate of blood loss was: group I – 5.118±2.38 ml/min, II – 4.507±2.215 ml/min, group III – 3.416±1.059 ml/min.

CONCLUSIONS

In TIVA the advanced technologically control of a drug dose allows for a better control of hypotension, which, finally, results in lower haemorrhage within the operation area, a favourable condition for both a patient and a physician. Perioperative bleeding was independent on sex in every type of anaesthesia.