• Mohamad R Chaaban, Fuad M Baroody, Ori Gottlieb, and Robert M Naclerio.
• Department of Surgery, Section of Otolaryngology–Head and Neck Surgery, University of Chicago Medical Center, Chicago, IL, USA.
• JAMA Otolaryngol Head Neck Surg. 2013 May 1;139(5):510-4.

ImportanceTotal intravenous anesthesia (TIVA) with propofol has been associated with reduced operative time, decreased perioperative risks, and decreased intraoperative blood loss compared with inhalational anesthesia (IA). During endoscopic sinus surgery (ESS), reduced bleeding from the mucosal surfaces could improve visualization of the anatomy and decrease the risk of serious complications.ObjectiveTo compare blood loss during ESS between patients receiving TIVA with propofol and those receiving IA with sevoflurane.Design, Setting, And ParticipantsProspective, randomized study of 33 patients undergoing ESS in an academic medical center.InterventionsPatients received either TIVA or IA.Main Outcomes And MeasuresThe primary outcome was rate of blood loss in milliliters per hour. The secondary outcomes included the quality of visibility measured by the surgeon's numeric rating score, ease of anesthesia as measured by the anesthesiologist's numeric rating score, and total blood loss.ResultsThe mean (SEM) blood loss per hour in the TIVA group was 78.5 (14) mL/h, and in the IA group it was 80.3 (17) mL/h (P = .93). A post hoc subgroup analysis found that in patients with a Lund-Mackay score of 12 or lower, the propofol TIVA group had a lower rate of blood loss compared with the sevoflurane IA group (mean blood loss, approximately 18 mL/h vs approximately 99 mL/h). The anesthesiologist's numeric rating score was significantly higher (indicating greater ease of performance) in the IA group than in the TIVA group. There was no statistically significant difference in the surgical numeric rating score between the 2 groups.Conclusions And RelevanceIn this comparative study, our results did not show any difference in blood loss and surgical conditions between the TIVA and IA groups. Even further study is not likely to show a difference in blood loss between TIVA and IA during ESS.

This article appears in the collection: Sinus surgery, intravenous anaesthesia and bleeding.

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