Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
the NSURG, Prince of Wales Private Hospital, Sydney, NSW, Australia.
Laryngoscope. 2020 Mar;130(3):575-583. doi: 10.1002/lary.28046. Epub 2019 May 3.
Achieving optimal intraoperative surgical field visibility and minimizing blood loss are two important parameters in endoscopic sinus surgery (ESS). The aim of this meta-analysis was to compare two total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) to determine if either conferred superior outcomes of these and other parameters based on randomized control trials (RCTs) only.
The recommended Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed, and searches of electronic databases from inception to September 2018 identified 157 articles for screening. Data were extracted and analyzed using meta-analysis of proportions.
In total, we identified 15 RCTs that satisfied our selection criteria. There were 828 ESS cases described, with 391 (47%) and 437 (53%) being managed by TIVA and IA, respectively. Pooled analysis demonstrated significantly superior visibility scores for TIVA compared to IA based on 10-point grading scores (P = 0.049, visual analog scale; P = 0.009, Wormald scale) and 5-point grading scores (P = 0.002, Boezaart scale). Blood loss was significantly less following TIVA (P = 0.003), with no significant difference in intraoperative heart rate (P = 0.70) or mean arterial pressure (P = 0.96). Additionally, duration of surgery (P = 0.16) and anesthesia (P = 0.39) were comparable between the two approaches.
This meta-analysis indicates that TIVA has the potential to confer superior surgical field visibility and reduce intraoperative blood loss compared to IA in ESS. Currently, there are significant heterogeneity concerns in this meta-analysis, which temper any expectations that either approach is absolutely superior to the other. Caution should be exercised when interpreting these results until further validation can be achieved.
1A Laryngoscope, 130:575-583, 2020.
在鼻窦内窥镜手术（ESS）中，实现最佳的术中手术视野可见度和最小化出血量是两个重要参数。本荟萃分析的目的是比较两种全凭静脉麻醉（TIVA）和吸入麻醉（IA），以确定基于随机对照试验（RCT）的这两种方法或其他方法是否具有更好的结果。
我们遵循了系统评价和荟萃分析推荐的首选报告项目指南，并对从开始到 2018 年 9 月的电子数据库进行了搜索，筛选出 157 篇文章进行筛选。使用比例的荟萃分析提取和分析数据。
总共确定了 15 项符合我们选择标准的 RCT。描述了 828 例 ESS 病例，其中 391 例（47%）和 437 例（53%）分别由 TIVA 和 IA 管理。基于 10 分分级评分（P = 0.049，视觉模拟评分；P = 0.009，Wormald 评分）和 5 分分级评分（P = 0.002，Boezaart 评分）的荟萃分析表明，TIVA 的可见度评分明显优于 IA。TIVA 后出血量明显减少（P = 0.003），术中心率（P = 0.70）或平均动脉压（P = 0.96）无显著差异。此外，两种方法之间的手术持续时间（P = 0.16）和麻醉持续时间（P = 0.39）相当。
本荟萃分析表明，与 IA 相比，TIVA 有可能在 ESS 中提供更好的手术视野可见度并减少术中出血量。目前，该荟萃分析存在显著的异质性问题，这降低了对任何一种方法绝对优于另一种方法的期望。在可以进一步验证之前，应谨慎解释这些结果。
1A 喉镜，130:575-583，2020。
