Evaluation of Surgical Conditions during Elective Endoscopic Sinus Surgery with Total Intravenous Anesthesia and Monitored Anesthesia Care
Sanjeev Kumar Singla, Ankush Singla
Keywords :
Endoscopic sinus surgery, Monitored anesthesia care, Total intravenous anesthesia
Citation Information :
Singla SK, Singla A. Evaluation of Surgical Conditions during Elective Endoscopic Sinus Surgery with Total Intravenous Anesthesia and Monitored Anesthesia Care. Clin Rhinol An Int J 2023; 14 (1--3):1-4.
Background: The diseases of sinuses are commonly seen in all age groups. Currently, endoscopic sinus surgery (ESS) is commonly performed as a daycare procedure. The anesthetic technique should also be selected on this basis. Keeping these considerations in view, ESS has been performed under total intravenous anesthesia (TIVA) using or monitored anesthesia care (MAC).
Materials and methods: This prospective randomized open-level study was conducted in 40 ASA I–II adult patients of either sex, undergoing elective ESS. All the patients were divided into two groups according to the randomized table: Group A: TIVA and group B: local anesthesia and conscious sedation. In group B, patients who did not tolerate the procedure were converted to the TIVA group.
Results: The duration of surgical procedure was 69.00 ± 9.63 minutes in group A patients and 55.00 ± 10.34 minutes in group B patients. This result was statistically significant. But in group A, 55% of patients had a score of 2, and 45% had a score of 3. In group B, 90% had a score of 2 and 10% had a score of 3. This was statistically significant (p < 0.05).
Conclusion: The time taken for ESS is reduced, the surgical field is better despite of higher mean blood pressure done with MAC care in comparison to TIVA. However, this needs the cooperative patient.
Gittleman PD, Jacobs JB. Skorina J. Comparison of functional endoscopic sinus surgery under local and general anaesthesia. Ann Otol Rhinol Laryngol 1993;102(4 Pt 1):283–293. DOI: 10.1177/000348949310200408.
Ebehart LH, Folz BJ, Wolf H, et al. Intravenous anaesthesia provides optimal surgical condition during microscopic and endoscopic sinus surgery. Laryngoscope 2003;113(8):1369–1373. DOI: 10.1097/00005537-200308000-00019.
Danielsen A. Functional endoscopic sinus surgery as a day care out-patient basis. Clin Otolaryngol Allied Sci 1992;17(6):473–477. DOI: 10.1111/j.1365-2273.1992.tb01699.x.
Nair S, Collins M, Hung P, et al. Effect of β-Blockers premedication on the surgical field during endoscopic sinus surgery. Laryngoscope 2004;114(6):1042–1046. DOI: 10.1097/00005537-200406000-00016.
Blackwell KE, Ross DA, Kapur P, et al. Propofol for maintenance of general anaesthesia a technique to limit blood loss during endoscopic sinus surgery. Am J Otolaryngol 1993;14(4):262–266. DOI: 10.1016/0196-0709(93)90072-f.
Fedok FG, Ferraro RE, Kingsley CP, et al. Operative times postanaesthesia recovery times and complications during sinonasal surgery using general anaesthesia and local anaesthesia with sedation. Otolaryngol Head Neck Surg 2000;122(4):560–566. DOI: 10.1067/mhn.2000.100495.
Fromme GA, Mackenzie RA, Gould AB, et al. Controlled hypotension for orthognathic surgery. Anesth Analag 1986;65(6):683–686. PMID: 3706806.
Mackay IS, Lon VJ. Surgical management of sinusitis. In: Makay IS, Bull TR, editors. Scott Browns Otolaryngology, 6th edition. Butterworth Heinmann 1997. pp. 5–26.
Stammberger H. Functional endoscopic sinus surgery. In: The Messerklinger Technique Edition. Philadelphia: BC Decker 1999. pp. 283–318.
Jakobsen J, Vendstrip S. Functional endoscopic sinus surgery in chronic sinusitis: A series of 237 consecutively operated patients. Acta Otolaryngol Suppl 2000;543:158–161. DOI: 10.1080/000164 800454279.
Keleş N, Ilicali OC, Değer K. Objective and subjective assessment of nasal obstruction in patients undergoing endoscopic sinus surgery. Am J Rhinol 1998;12(5):307–309. DOI: 10.2500/105065898780182408.
Sun H, Tan G, Xiao J. Endoscopic sinus surgery, clinical expect with 69 cases. Zhonghue Er Bi Yan Hou Ke Za Zhi 1996;31(1):18–19. PMID: 9275396.
Sipila J, Antila J, Suonpaa J. Pre and postoperative evaluation of patients with nasal obstruction undergoing endoscopic sinus surgery. Eur Arch Otorhinolaryngol 1996;253(4–5):237–239. DOI: 10.1007/BF00171134.
Wang L, Kim J, Heilman CB. Intracranial mucocele as a complication of endoscopic repair of cerebrospinal fluid rhinorrhea: Case report. Neurosurgery 1999;45(5):1243–1245. DOI: 10.1097/00006123-199911000-00052.
Jones GW. Anaesthesia for ENT surgery. In: Aitkentre AR Rowbotham DJ, Smith G, editors. Textbook of Anaesthesia. 4th edition. London: Churchill Living Stone; 2001. pp. 590–593.
Stammberger H, Hawke M. Essentials of Endoscopic Sinus Surgery. 2nd edition. Mosby; 2000. pp. 143–144.
Ronald D Miller. Miller's Anesthesia. 6th edition, vol. 1. Elsevier, Churchill Livingstone; 2004. pp. 335–344.
Stoelting RK. Pharmacology and Physiology in Anesthetic Practice. 3rd edition. Lippincott-Raven 1999. pp. 93–96.
Degoute CS, Dubreuil E, Ray MJ, et al. Effects of posture, hypotension and locally applied vasoconstrictors on the middle ear microcirculation in anaesthetized humans. Eur J Appl Physol Occup Physiol 1994;69(5):414–420. DOI: 10.1007/BF00865405.
Degoute CS, Ray MJ, Manchon M, et al. Remifentanil controlled hypotension, comparison with nitroprusside or esmolol during tympanoplasty. Can J Anesth 2001;48(1):20–27. DOI: 10.1007/BF03019809.
Boezart AP, Vander MJ, Coetzee AR. Comparison of sodium nitroprusside and esmolol controlled hypotension for functional endoscopic sinus surgery. Can J Anesth 1995;42(5 Pt 1):373–376. DOI: 10.1007/BF03015479.
Ankichetty SP, Ponniah M, Cherian V, et al. Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol 2011;27(3):328–332. DOI: 10.4103/0970-9185.83675.
Vleming M, Middel Weerd RJ, Devries N. Complications of endoscopic sinus surgery. Arch Otolaryngol Head Neck Surg 1992;118(6):617–623. DOI: 10.1001/archotol.1992.01880060067015.
Maier W, Laszig R. Complication of endonasal paranasal sinus surgery – Diagnostic and therapeutic consequences. Laryngorhinootolgie 1998;77(7):402–409. DOI: 10.1055/s-2007-996998.
Unlu NH, Goktan C, Astan A, et al. Injury to lacrimal apparatus after endoscopic sinus surgery, surgical implications from active transport dacryocystography. J Otolaryngol Head Neck Surg 2001;124(3): 308–312. DOI: 10.1067/mhn.2001.112433.