Author(s)
Peter Benjamin, BS
John Sawires, BA
Peter Girgis, BS
David Ayob, BS
Frederick Durrant, MD, Dr
Avigeet Gupta, MD
Andrey Filimonov, MD, PharmD
Jean Anderson Eloy, MD, FARS
Affiliation(s)
Rutgers New Jersey Medical School
Abstract:
Background
Endoscopic Sinus Surgery (ESS) requires optimization of surgical field conditions to provide enhanced visibility. It is theorized that choice of anesthetic can determine these conditions. This study aims to assess the differences between use of total intravenous anesthesia (TIVA) and inhaled anesthesia (IA) and resultant intra-operative factors such as blood loss, surgical visibility, mean arterial pressure (MAP) control, and operative time.
Methods
This Meta-analysis was conducted using PRISMA guidelines. A comprehensive literature search identified 385 studies, 14 of which met inclusion criteria with a total of 1431 patients. Further evaluation using the Oxford Jadad scale yielded 9 high-quality studies and 5 low-quality studies.
Results
Of 385 studies screened, 14 met inclusion criteria. Fourteen studies demonstrated no significant difference in operative duration between techniques (MD -2.10 minutes [95% CI -8.36 to 4.15]; P = 0.51; I² = 80%). Ten studies evaluated intraoperative blood loss and showed that TIVA was associated with significantly reduced blood loss compared with IA (MD -52.02 mL [95% CI -100.22 to -3.82]; P = 0.03; I² = 93%). Seven studies assessed mean arterial pressure and found no significant difference between anesthesia techniques (MD 1.56 mmHg [95% CI -1.30 to 4.23]; P = 0.25; I² = 77%). Similarly, seven studies evaluating heart rate demonstrated no significant difference (MD 0.67 bpm [95% CI -3.25 to 4.59]; P = 0.74; I² = 81%). Seven studies reported surgical field quality scores, with no significant difference between techniques (MD -0.26 [95% CI -0.64 to 0.12]; P = 0.18; I² = 91%). Four studies evaluated postoperative nausea and vomiting and showed no significant difference (OR 1.00 [95% CI 0.33–3.05]; P = 1.00; I² = 0%). Finally, four studies assessed PACU length of stay and demonstrated that TIVA was associated with a modest but statistically significant reduction in recovery time (MD -1.16 [95% CI -2.18 to -0.13]; P = 0.03; I² = 0%).
Conclusion
Current evidence suggests that use of TIVA may provide benefits with reduced intraoperative blood loss and shorter PACU stay. However, results are comparable regarding operative duration, hemodynamics, surgical field quality, and PONV. However, high heterogeneity across outcomes warrant cautious interpretation. Future studies should evaluate rates of post-operative outcomes to identify clinical benefits between the two anesthesia modalities.