Purpose: Regarding the quality of surgical field visibility, previous studies and meta-analyses comparing total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) in endoscopic sinus surgery (ESS) have presented inconsistent findings. Considering that IA has some advantages over TIVA, we aimed to test the hypothesis that IA with sevoflurane-remifentanil is noninferior to TIVA with propofol-remifentanil in terms of surgical field visibility quality during ESS.
Patients and Methods: In this randomized, double-blind, noninferiority clinical trial, 110 adult patients were recruited and randomly assigned to the IA (n = 55) or TIVA (n = 55) group. The primary outcome was the quality of surgical field visibility, as measured by the intraoperative mean Boezaart score (BS). Additionally, post hoc analysis was performed for patients with Lund-Mackay scores of ≤ 12 or > 12. Other secondary outcomes included total blood loss, bleeding rate, total fluid, mean arterial pressure, heart rate, dose of remifentanil for anesthesia maintenance, end-tidal CO₂, length of stay in the post anesthesia care unit, postoperative hypoxemia, sore throat, and nausea.
Results: The intraoperative mean BS of the IA group was noninferior to that of the TIVA group [medians with interquartile ranges (IQRs), 2.0 (1.7– 2.2) vs 2.0 (1.8– 2.1), P = 0.923]. Moreover, post hoc analysis confirmed no difference between IA and TIVA for patients with Lund-Mackay scores ≤ 12 (P = 0.403) or > 12 (P = 0.226). No differences in total blood loss, bleeding rate, or other intraoperative indicators or complications were observed between groups.
Conclusion: Regarding surgical field visibility during ESS, IA with sevoflurane-remifentanil is noninferior to TIVA with propofol-remifentanil anesthesia maintenance.
Keywords: sevoflurane, remifentanil, propofol, blood loss, bleeding rate, Boezaart score