• Suneeta Gollapudy, Drake A Gashkoff, David M Poetker, Todd A Loehrl, and Matthias L Riess.
• Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
• Otolaryngol Head Neck Surg. 2020 Oct 1; 163 (4): 835-842.

ObjectiveTo assess if the type of general anesthetic affects bleeding and field visualization during endoscopic sinus surgery.Study DesignProspective, randomized, controlled trial.SettingAcademic teaching hospital and Veterans Affairs hospital in the United States.Subjects And MethodsSeventy patients were randomized to 1 of 3 anesthetic regimens: (1) the volatile anesthetic desflurane (n = 22), (2) intravenous anesthesia with propofol (n = 25), or (3) a combination of propofol and desflurane (n = 23). Intravenous remifentanil was titrated to decrease the mean arterial pressure to 60 to 70 mm Hg but not ≥30% from baseline. Surgical bleeding scores were recorded along with bleeding rates and hemodynamic parameters, including cardiac output and systemic vascular resistance through pulse contour analysis from a radial arterial line. Statistics: multiple comparison tests and regression analyses; α = .05.ResultsThere were no differences in bleeding rate (median, 0.58, 0.85, 0.57 mL min-1), bleeding score (2.1, 2.0, 2.0), surgery duration (79, 81, 86 minutes), extubation time (9, 7, 8 minutes), recovery room time (65, 61, 61 minutes), or any hemodynamic parameters among groups 1 through 3, respectively. Group 1 required lower remifentanil infusions than group 2 (0.11 vs 0.26 µg kg-1 min-1; P = .01). The bleeding score correlated positively with height (P = .014) and the Lund-MacKay score (P = .013). Bilateral vs unilateral surgery led to longer surgery duration (P = .001) and recovery room time (P = .004).ConclusionWhen remifentanil is used for controlled hypotension, propofol has no advantage over desflurane to improve surgical field visualization during functional endoscopic sinus surgery.

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