Anesthetic techniques and haemodynamic control for Endoscopic Sinus Surgery: A retrospective analysis and review of literature

Introduction
Bleeding from mucosal edges is known to decrease surgical visibility and increase the risk of complications in Endoscopic sinus surgery (ESS). A variety of strategies, including modifying anesthetic techniques have been proposed to create a bloodless field. A recent survey in anesthesiologist revealed that a vast majority neither use controlled hypotension nor believe that modifying the anesthetic techniques will improve the outcome of ESS. This study investigates the different anesthetic techniques used for ESS and their effect on the haemodynamic variables achieved intra-operatively.
Methods
Data were retrospectively collected from an electronic anesthesia database on 233 consecutive adult patients who underwent endoscopic sinus surgery in a tertiary hospital in Singapore from January 2014 to August 2015 and statistical analysis was performed using SPSS.
Results
Inhaled anesthetics (IA) were used for 93% (49% with morphine or fentanyl, 42% with remifentanil) and total intravenous anesthesia (TIVA) for 7% of the cases respectively. The airway was secured with endotracheal tube in 94.6% and the rest were having LMA. Average Mean Arterial Pressure (MAP) lower than 70 mmHg was achieved in 74.4%. Antihypertensive drugs were used only in 5 cases (2.3%). Distribution of intra operative MAP and Heart rate (HR) were similar among different anesthetic techniques. Lowest MAP and HR achieved were significantly lower in IA with remifentanil use.
Conclusion
Inhaled anesthesia is the preferred maintenance technique used for ESS. The desired MAP range was achieved in about 75% of the cases without needing anti hypertensives. Use of remifentanil reduces the MAP and HR further which might potentially improve the quality of surgical field and the outcome.