• Benjamin J Heller, Samuel DeMaria, Erick Mendoza, Jaime Hyman, Alfred M C Iloreta, Hung-Mo Lin, Satish Govindaraj, and Adam I Levine.
• The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
• Laryngoscope. 2020 May 1; 130 (5): E299-E304.

BackgroundFunctional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N2 O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery.MethodsPatients were randomized to either a N2 O-based (nitrous oxide with propofol and remifentanil) or TIVA (propofol and remifentanil without nitrous oxide) group. The surgeon was blinded to the anesthetic technique. Surgical field grading was performed in real time by the otolaryngologist every 15 minutes with the Boezaart grading system.ResultsThere were no statistically significant differences between the Boezaart scores, duration of surgery, or estimated blood loss between the two anesthetic techniques. However, the use of N2 O provided a statistically significant, 38% reduction in time from surgery end to extubation. The TIVA group had significantly decreased mean and median pain scores in the post-anesthesia care unit (PACU). There was no difference in the rate of postoperative nausea and vomiting between the two groups.ConclusionA N2 O-based anesthetic for functional endoscopic sinus surgery provides similar intraoperative and postoperative conditions when compared to TIVA, while being superior in terms of time to extubation. Although the TIVA group had significantly decreased pain scores, this did not lead to a decrease in pain medicine received in the PACU, and there was no difference between groups in time to discharge.Level Of Evidence1b Laryngoscope, 130:E299-E304, 2020.© 2019 The American Laryngological, Rhinological and Otological Society, Inc.

31 keywords...

hide…