The Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.
Laryngoscope. 2020 May;130(5):E299-E304. doi: 10.1002/lary.28201. Epub 2019 Aug 1.
Functional endoscopic sinus surgery is a common procedure for sinonasal disease, frequently performed in the outpatient setting. General anesthesia maintained with total intravenous anesthesia (TIVA) with propofol has been shown to give superior surgical conditions compared to inhaled anesthetics. This study evaluated the effects of TIVA versus a predominantly nitrous oxide (N O)-based anesthetic with a low-dose propofol and remifentanil infusion on sinus surgery.
Patients were randomized to either a N O-based (nitrous oxide with propofol and remifentanil) or TIVA (propofol and remifentanil without nitrous oxide) group. The surgeon was blinded to the anesthetic technique. Surgical field grading was performed in real time by the otolaryngologist every 15 minutes with the Boezaart grading system.
There were no statistically significant differences between the Boezaart scores, duration of surgery, or estimated blood loss between the two anesthetic techniques. However, the use of N O provided a statistically significant, 38% reduction in time from surgery end to extubation. The TIVA group had significantly decreased mean and median pain scores in the post-anesthesia care unit (PACU). There was no difference in the rate of postoperative nausea and vomiting between the two groups.
A N O-based anesthetic for functional endoscopic sinus surgery provides similar intraoperative and postoperative conditions when compared to TIVA, while being superior in terms of time to extubation. Although the TIVA group had significantly decreased pain scores, this did not lead to a decrease in pain medicine received in the PACU, and there was no difference between groups in time to discharge.
1b Laryngoscope, 130:E299-E304, 2020.
功能性内镜鼻窦手术是治疗鼻-鼻窦疾病的常见手术，通常在门诊进行。与吸入麻醉相比，丙泊酚全凭静脉麻醉（TIVA）维持的全身麻醉可提供更优的手术条件。本研究评估了 TIVA 与以低剂量丙泊酚和瑞芬太尼输注为主的含一氧化二氮（N O）麻醉对鼻窦手术的影响。
患者随机分为 N O 组（一氧化二氮、丙泊酚和瑞芬太尼）或 TIVA 组（无一氧化二氮的丙泊酚和瑞芬太尼）。外科医生对麻醉技术不了解。耳鼻喉科医生每 15 分钟使用 Boezaart 分级系统实时进行手术视野分级。
两种麻醉技术之间的 Boezaart 评分、手术持续时间或估计失血量均无统计学差异。然而，使用 N O 可使手术结束至拔管的时间显著缩短 38%。TIVA 组患者在麻醉后护理单元（PACU）的平均和中位数疼痛评分显著降低。两组之间术后恶心和呕吐的发生率无差异。
与 TIVA 相比，用于功能性内镜鼻窦手术的 N O 基麻醉在术中及术后条件相似，但在拔管时间方面更优。虽然 TIVA 组的疼痛评分显著降低，但这并未导致 PACU 中止痛药使用量减少，两组之间在出院时间方面无差异。
1b 喉镜，130：E299-E304，2020 年。
