Department of Otolaryngology-Head & Neck Surgery, Tulane University, New Orleans, LA.
Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, GA.
Int Forum Allergy Rhinol. 2018 Oct;8(10):1114-1122. doi: 10.1002/alr.22173. Epub 2018 Jul 6.
Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high-grade inflammatory disease, suggesting a role for TIVA in that disease subgroup.
A double-blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high-grade CRS defined as either sinonasal polyposis or a preoperative Lund-Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10-point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22-item Sino-Nasal Outcome Test (SNOT-22).
A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4-3.9] vs IA 4.1[3.0-5.8], p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100-450] vs 300 mL [200-500], p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT-22 scores at 3 months (p = 0.278) and at 6 months (p = 0.396) following ESS.
TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high-grade inflammatory sinus disease.
全凭静脉麻醉（TIVA）已被提议用于减少内镜鼻窦手术（ESS）中的失血量。由于粘膜出血导致的鼻-鼻窦可视化受损，在伴有高级别炎症性疾病的慢性鼻-鼻窦炎（CRS）患者中可能会带来负担，这表明 TIVA 在该疾病亚组中具有一定作用。
在一家三级医疗中心进行了一项双盲、随机对照试验，纳入了接受 ESS 的成年患者。纳入的患者被认为患有高级别 CRS，定义为鼻-鼻窦息肉或术前 Lund-Mackay 评分≥12 分。患者被随机分为接受 TIVA 或吸入麻醉（IA）进行 ESS。主要观察指标是由 3 名盲法评估者利用 10 分制 Wormald 手术视野分级量表评定的术中可见度。次要结局指标包括手术失血量、并发症以及 22 项 Sino-Nasal Outcome Test（SNOT-22）评估的生活质量变化。
共有 72 例患者被随机分为 TIVA（n=37）和 IA（n=35）研究组。所有评估者的 Wormald 评分总和中位数（四分位距）显示，TIVA 组的视野更有利，优于 IA 组（3.5[2.4-3.9]vs IA 4.1[3.0-5.8]，p=0.0089）。TIVA 组的失血量明显少于 IA 组（200mL[100-450]vs 300mL[200-500]，p=0.046）。两组患者的基线特征相似，术后无明显并发症。ESS 后 3 个月（p=0.278）和 6 个月（p=0.396）时，SNOT-22 评分无显著变化。
TIVA 有助于改善高级别炎症性鼻窦疾病患者接受 ESS 时的术中可视化和减少失血量。
