School of Medicine, University of Texas Medical Branch, Galveston, Texas.
Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Rhinol Allergy. 2021 Sep;35(5):674-684. doi: 10.1177/1945892421989155. Epub 2021 Jan 21.
Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility.
To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility.
A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP).
19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (-0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (-0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (-0.225, p = 0.63) and MAP values (-0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent.
TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.
先前的研究和荟萃分析分别导致了不一致和不完整的结果，当在鼻内镜鼻窦手术中比较全凭静脉麻醉（TIVA）和吸入麻醉（IA）时，涉及术中出血和可见度。
对比较鼻内镜鼻窦手术中 TIVA 与 IA 的随机对照试验（RCT）进行更全面的荟萃分析，以评估它们对术中出血和可见度的影响。
2020 年 5 月完成了一项比较慢性鼻-鼻窦炎鼻内镜鼻窦手术中 TIVA 与 IA 的系统评价和荟萃分析。利用数据库，系统地筛选文章进行分析，有 19 项研究符合我们的纳入标准。主要结局包括术中可见度评分，结合 Boezaart、Wormald 和视觉模拟量表（VAS）。次要结局包括失血量（mL/kg/min）、估计总失血量（mL）、Boezaart、Wormald 评分、VAS、心率和平均动脉压（MAP）。
分析了 19 项 RCT 和 1010 例患者。TIVA 的术中出血量评分明显低于 IA，表明内镜可见度更好（Boezaart、VAS 和 Wormald）（-0.514，p=0.020）。IA 的平均失血量比 TIVA 高 0.563 mL/kg/min（p=0.016）。TIVA 的估计总失血量明显低于 IA（-0.853 mL，p=0.002）。TIVA 与 IA 的平均心率（-0.225，p=0.63）和 MAP 值（-0.126，p=0.634）无显著差异。亚组分析显示，当不使用瑞芬太尼和使用地氟醚作为 IA 药物时，TIVA 与 IA 之间无显著差异。
与 IA 相比，TIVA 似乎在鼻内镜鼻窦手术中具有更好的术中可见度评分和出血量。然而，当根据瑞芬太尼的使用和不同的吸入麻醉剂对结果进行分层时，结果并不一致。因此，不能得出一种方法优于另一种方法的结论。
