Users Online: 661 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 
 

 
Table of Contents
ORIGINAL ARTICLE
Year : 2011  |  Volume : 27  |  Issue : 3  |  Page : 328-332

Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery


1 Department of Anaesthesia and Critical Care, Christian Medical College and Hospital, Vellore, India
2 Department of O and G, Christian Medical College and Hospital, Vellore, India
3 Department of Anaesthesia and Critical Care, Post Graduate Institute of Medical Sciences, Rohtak, India

Date of Web Publication11-Aug-2011

Correspondence Address:
Saravanan P Ankichetty
Department of Anaesthesia and Critical Care, Christian Medical College and Hospital, Vellore - 632 004, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9185.83675

Rights and Permissions
   Abstract 

Background: An important requirement during functional endoscopic sinus surgery is to maintain a clear operative field to improve visualization during surgery and to minimize complications.
Materials and Methods: We compared total intravenous anesthesia using propofol with inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. It was a prospective study in a tertiary hospital in India. Forty ASA physical status I and II adult patients (16-60 years) were randomly allocated to one of two parallel groups (isoflurane group, n = 20; propofol group, n=20). The primary outcome was to know whether total intravenous anesthesia using propofol was superior to inhalational anesthesia using isoflurane for controlled hypotension. The secondary outcomes measured were intraoperative blood loss, duration of surgery, surgeon's opinion regarding the surgical field and the incidence of complications.
Results: The mean (±SD) time to achieve the target mean blood pressure was 18 (±8) minutes in the isoflurane group and 16 (±7) minutes in the propofol group ( P = 0.66). There was no statistically significant difference (P = 0.402) between these two groups in terms of intraoperative blood loss and operative field conditions (P = 0.34).
Conclusions: Controlled hypotension can be achieved equally and effectively with both propofol and isoflurane. Total intravenous anesthesia using propofol offers no significant advantage over isoflurane-based anesthetic technique in terms of operative conditions and blood loss.

Keywords: Anesthetic techniques, hypotensive, isoflurane, otolaryngological surgeries, propofol


How to cite this article:
Ankichetty SP, Ponniah M, Cherian V T, Thomas S, Kumar K, Jeslin L, Jeyasheela K, Malhotra N. Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol 2011;27:328-32

How to cite this URL:
Ankichetty SP, Ponniah M, Cherian V T, Thomas S, Kumar K, Jeslin L, Jeyasheela K, Malhotra N. Comparison of total intravenous anesthesia using propofol and inhalational anesthesia using isoflurane for controlled hypotension in functional endoscopic sinus surgery. J Anaesthesiol Clin Pharmacol [serial online] 2011 [cited 2019 May 26];27:328-32. Available from: http://www.joacp.org/text.asp?2011/27/3/328/83675


   Introduction Top


The aim of functional endoscopic sinus surgery (FESS) is to restore the drainage and aeration of the paranasal sinuses, while maintaining the natural mucociliary clearance mechanism and seeking to preserve the normal anatomic structures. [1],[2] However, this surgery can lead to complications such as orbital cellulitis, rhino-oral fistulas and damage to the optic nerve. [2],[3],[4] It is important to have a clear surgical field to minimize the complications. General anesthesia is often preferred over topical anesthesia because of the discomfort, and because incomplete block may be associated with topical anesthesia. Moreover, general anesthesia allows achieving hypotensive anesthesia. [4] Controlled hypotension is required in FESS procedures for better visualization and to minimize operative time and blood loss. Various agents like beta-blockers, alpha and beta blockers, alpha agonists, vasodilators, magnesium sulfate have been used to achieve controlled hypotension. [5],[6] Isoflurane-based inhalational anesthetic technique for achieving controlled hypotension has gained wide popularity. Total intravenous anesthesia (TIVA) using propofol and remifentanil is a common practice in Western countries. Remifentanil is not freely available in India. This study was designed to evaluate TIVA with propofol and fentanyl and to determine whether controlled hypotension and better operative conditions can be achieved when compared to conventional isoflurane-based inhalational anesthetic technique.


   Materials and Methods Top


The study protocol was approved by the institutional research and ethics committee and patients gave written informed consent. Sample size was calculated by a statistician as 20 in each group, based on previous studies to achieve a power of 80% and an alpha error of 0.05. Forty patients admitted during the one-year period to a tertiary care teaching hospital in India, belonging to ASA physical status I, aged 16-60 years, undergoing FESS were randomly allocated as per the computer-generated simple randomization code to one of the two parallel groups (isoflurane group, n0 = 20; propofol group, n=20). Patients with bleeding disorders, major hepatic, renal or cardiovascular dysfunction, recurrent endoscopic sinus surgeries and anticoagulation therapy were excluded. The primary outcome was to know whether TIVA using propofol was superior to inhalational anesthesia using isoflurane for controlled hypotension. The secondary outcomes measured were intraoperative blood loss, duration of surgery, surgeon's opinion regarding the surgical field and the incidence of complications.

The allocation sequence was generated by the statistician. Allocation concealment was ensured with the use of sealed envelopes. The principal investigator enrolled the patients and following recruitment, the allocation was revealed in the operating room to the anesthesiologist anesthetizing the patients. Double blinding was not possible because of the nature of the study. The anesthesiologist was not blinded to the study drug but the anesthesiologist assessing the blood loss was blinded to the study drug.

The study patients were kept fasted as per the standard guidelines and premedicated with oral diazepam 0.2 mg kg -1 one hour prior to the induction of anesthesia. On arrival to the operating room, an intravenous (IV) line was sited and monitoring that included pulse oximetry (SpO 2 ), noninvasive blood pressure (NIBP), electrocardiogram (ECG), end tidal carbon dioxide (EtCO 2 ) and end tidal isoflurane agent analyzer was established. Neuromuscular blockade was monitored with a nerve stimulator.

Heart rate with ST segment analysis, mean arterial pressure (MAP) and peripheral arterial oxygen saturation (SpO 2 ) were recorded before induction of anesthesia. After preoxygenation, induction of anesthesia was done with midazolam (2 mg), fentanyl (2 μg kg -1 ) and propofol (2 mg kg -1 ) IV. After ensuring adequate ventilation, vecuronium (0.1 mg kg -1 ) was administered via a fast-flowing IV infusion over five seconds. Orotracheal intubation was performed and the lungs were ventilated. Oropharynx was packed with a saline-soaked throat pack. An infusion of fentanyl was started at the rate of 2 μg kg -1 h -1 following intubation in both groups.


   Group 1 (Inhalational anesthesia) Top


Induction of anesthesia was done and maintained with 50% oxygen in air, and isoflurane. The concentration of isoflurane was adjusted using agent analyzer according to the patient's response and to achieve a mean arterial pressure between 60 and 70 mmHg. However, it was decided not to exceed the end tidal concentration of isoflurane above 2%.


   Group 2 (TIVA) Top


Induction of anesthesia was done and maintained with 50% oxygen in air, propofol infusion started at 12 mg kg -1 h -1 for 10 min following intubation, then 10 mg kg -1 h -1 for next 10 min and continued at 8 mg kg -1 h -1 . The infusion rate was increased according to the patient's response and to achieve a mean arterial pressure between 60 and 70 mmHg. However, it was decided not to exceed the maximal rate of propofol infusion above 12 mg kg -1 h -1 .

During the perioperative period, both groups received IV normal saline at 4 ml kg -1 h -1 . Neuromuscular blockade was achieved with an intermittent boluses of vecuronium adjusted to provide complete depression of the first twitch after TOF stimulation. Normothermia was maintained during the whole procedure. The volume of blood which was sucked and collected in the bottle was measured to assess the amount of blood loss. The second anesthesiologist who was not involved in the study made visual assessment of blood-soaked gauze pieces used during the surgery. This was added to the amount of blood loss. The infusion of fentanyl was stopped 30 min before the completion of the surgical procedure in all the patients. Ondansetron 4 mg IV was given at the end of the surgery. The throat pack was removed at the end of the endoscopic procedure. The residual neuromuscular blockade was reversed with 0.05 mg kg -1 of neostigmine and 0.02 mg kg -1 atropine IV.

Patients were followed up and monitored for pain, sedation score, nausea and vomiting in the post-operative period for 48 h. For evaluation of the visibility of the operative field during surgery, the quality scale proposed by Fromm and Boezaart [4] was used. The operative field conditions were assessed by the same operating surgeon as:

Grade 0: No bleeding.

Grade 1: Slight bleeding - No suctioning of blood required.

Grade 2: Slight bleeding - Occasional suctioning required. Surgical field not threatened.

Grade 3: Slight bleeding - Frequent suctioning required. Bleeding threatens surgical field a few seconds after suction is removed.

Grade 4: Moderate bleeding - Frequent suctioning required. Bleeding threatens surgical field directly after suction is removed.

Grade 5: Severe bleeding - Constant suctioning required. Bleeding appears faster than can be removed by suction. Surgical field severely threatened and surgery impossible.

The data were entered into a Microsoft Excel Computer Programme. Data were analyzed using the SPSS software (version 13.0). Descriptive statistics in the form of frequencies, median and means, standard deviations were calculated. The variations in the HR, MAP within each group were analyzed using repeated measures ANOVA and compared between the groups using Student's t test. A P-value <0.05 was considered significant.


   Results Top


Forty ASA physical status I and II patients undergoing FESS were studied (isoflurane group, n = 20; propofol group, n 0= 20). Patients of both groups were comparable in relation to age and height but varied in their weight [61.95(±10.72) vs. 53.80(±10.95), P = 0.023] [Table 1]. The mean (±SD) time to achieve the target blood pressure in isoflurane groups was 18(±8) minutes and 16(±7) minutes in the propofol group. There was no statistical difference ( P = 0.66) between the two groups with regard to median time in achieving target blood pressure (18-28) min [Figure 1]. When compared to the baseline, there was no significant difference between the two groups with regards to heart rate at different time intervals [Figure 2]. There was no significant difference between these two groups in terms of intraoperative blood loss [Table 2].
Figure 1: Mean arterial pressure (mmHg) in the two groups at different time intervals

Click here to view
Figure 2: Mean heart rate (beats min– 1) in the two groups at different time intervals

Click here to view
Table 1: Demographic data

Click here to view
Table 2: Intraoperative blood loss (ml) in the two groups

Click here to view
The operative field conditions assessed by the same surgeon were grade 3 and less in both the groups ( P = 0.34) [Figure 3]. The duration of surgery was less with propofol group when compared to isoflurane group [131(±36) vs. 98(±41) min, P = 0.01]. The mean fentanyl requirement was greater with isoflurane group [4.68 (±1) μg/kg vs. 3.94(±0.96) μg/kg, P = 0.026] when compared to propofol group. There was no statistical difference between the two groups in terms of sedation score, pain, nausea, vomiting and hospital-stay. None of them had intraoperative or postoperative complications.
Figure 3: Operative field conditions based on Fromm and Boezaart Scale in the two groups

Click here to view



   Discussion Top


Isoflurane-based inhalational anesthetic technique can be practiced wherever a general anesthetic is given. However, there is always a need to explore newer techniques and drugs to try and achieve better results and conditions for surgeries like FESS. One such technique that is gaining tremendous popularity for controlled hypotension is TIVA with propofol and remifentanil. It is not freely available and the cost of remifentanil in India would also be prohibitive for routine use. This study was designed to evaluate TIVA with propofol and fentanyl and to determine whether better results and operative conditions can be achieved when compared to conventional isoflurane-based inhalational anesthetic technique for controlled hypotension.

The goal of a target mean blood pressure of 60-70 mmHg was achieved in the groups in a mean time of 18(±8) min in isoflurane group and 16(±7) min in the propofol group and median time of 10 min in both the groups. Both isoflurane- and propofol-based techniques were equally capable of producing controlled hypotension. The highest concentration used in isoflurane group to achieve target blood pressure was an inspired concentration of 2.5% and end tidal concentration of 2%.

In a study by Tirelli et al., mean arterial pressure of 60-70 mmHg was aimed for in FESS. A concentration of 1-2% of isoflurane was used in the isoflurane group for the maintenance, which is almost similar to our study. In the TIVA group, hypotensive anesthesia was achieved using propofol and remifentanil. [7] Rate of propofol used was 35-45 ml hr -1 whereas in our study, we used the infusion rate based on the patient's body weight and hemodynamic response. Other factors which influence the propofol dosage requirement include age, weight, preexisting medical condition, type of surgical procedure and concomitant medical therapy. [8] In our study, maintenance of target blood pressure within the 60-70 mmHg range was more consistent with isoflurane group when compared to the propofol group and this was particularly appreciable when observing the graph [Figure 1], whereas there were several departures away from the target zone in the propofol group.

There was no significant difference between the two groups in terms of heart rate measured at different time intervals. The absence of tachycardia suggests that both the groups experienced adequate depth of anesthesia and analgesia because of the concomitant use of fentanyl. None of the patients had intraoperative awareness which was enquired in postoperative follow-up. There was no significant difference in the intraoperative blood loss between two groups. The reduced blood loss in both the groups reflects effective controlled hypotension by both the techniques.

Nair et al. described that patients on beta-blockers undergoing FESS had better surgical field with the heart rate less than 60 beats min -1 . [9] We achieved acceptable surgical conditions even though the heart rate in both the groups of our study was more than 60 beats min -1 . Mandal observed less bleeding with hypotensive anesthesia using isoflurane in FESS as compared to normotensive anesthesia provided by isoflurane. There were no postoperative complications due to intraoperative hypotension. [10]

Elsharnouby and Elsharnouby used magnesium sulfate for hypotensive anesthesia and observed a significant reduction in surgical time, blood loss, mean arterial blood pressure (P < 0.005) and heart rate (P < 0.005) in the magnesium group when compared to placebo group. [11] In our study, the operative field assessed by Fromme-Boezzart scale was similar in both the groups. All patients in both the groups belonged to grade 3 and below, which denotes highly acceptable surgical field as far as the surgeon was concerned. However, in the study by Tirelli, surgical field grading was better with propofol group when compared to isoflurane group. They also postulated that increased oozing in the isoflurane group could be due to the vasodilating property of isoflurane. [7] In our study, the mean fentanyl requirement was greater with isoflurane group when compared to the propofol group. This could be due to the longer surgery time in the isoflurane group when compared to propofol group. None of the patients in two groups had postoperative nausea and vomiting (PONV). This could be due to prophylactic administration of ondansetron and avoidance of nitrous oxide in both the groups. The use of propofol can be associated with less PONV or decreased requirements for antiemetic medication. [12] Antagonism of the dopamine D2 receptor by propofol has recently been suggested as a possible mechanism for this effect. [13] Visser et al. observed that TIVA using propofol results in a clinically relevant reduction of PONV compared with isoflurane-nitrous oxide anesthesia. [14] If this study had eliminated nitrous oxide in the inhalational group, as we did, they might have found lesser incidence of PONV in the inhalational group too.


   Conclusions Top


Controlled hypotension can be achieved equally and effectively by both isoflurane-based inhalational anesthetic technique and TIVA using propofol and fentanyl. TIVA using propofol offers no significant advantage over isoflurane-based inhalational anesthetic technique in terms of operative conditions and blood loss.


   Acknowledgement Top


We acknowledge the fluid research committee, Christian Medical College, Vellore for funding the study and the otolaryngological surgeons for their immense co-operation during the performance of study.

 
   References Top

1.Stammberger H, Posawetz W. Functional endoscopic sinus surgery. Concept, indications and results of the Messerklinger technique. Eur Arch Otorhinolaryngol 1990;247:63-76.  Back to cited text no. 1
[PUBMED]    
2.Stankiewicz JA. Complications of endoscopic intranasal ethmoidectomy. Laryngoscope 1987;97:1270-3.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Maniglia AJ. Fatal and other major complications of endoscopic sinus surgery. Laryngoscope 1991;101:349-54.  Back to cited text no. 3
[PUBMED]    
4.Boezaart AP, van der Merwe J, Coetzee A. Comparison of sodium nitroprusside- and esmolol-induced controlled hypotension for functional endoscopic sinus surgery. Can J Anaesth 1995;42:373-6.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Ryu JH, Sohn IS, Do SH. Controlled hypotension for middle ear surgery: A comparison between remifentanil and magnesium sulphate. Br J Anaesth 2009;229:1-6.  Back to cited text no. 5
    
6.Ray M, Bhattacharjee DP, Hajra B, Pal R, Chatterjee N. Effect of clonidine and magnesium sulphate on anaesthetic consumption, haemodynamics and postoperative recovery: A comparative study. Indian J Anaesth 2010;54:137-41.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
7.Tirelli G, Bigarini S, Russolo M, Lucangelo U, Gullo A. Total intravenous anaesthesia in endoscopic sinus-nasal surgery. Acta Otorhinolaryngol Ital 2004;24:137-44.  Back to cited text no. 7
[PUBMED]    
8.Smith I, White PF, Nathanson M, Gouldson R. Propofol: An update on its clinical use. Anesthesiology 1994;81:1005-43.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Nair S, Collins M, Hung P, Rees G, Close D, Wormald PJ. The effect of beta-blocker premedication on the surgical field during endoscopic sinus surgery. Laryngoscope 2004;114:1042-6.  Back to cited text no. 9
    
10.Mandal P. Isoflurane anesthesia for functional endoscopic sinus surgery. Indian J Anaesth 2003;47:37-40.  Back to cited text no. 10
  Medknow Journal  
11.Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anaesth 2006;96:727-31.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Price ML, Walmsley A, Swaine C, Ponte J. Comparison of total intravenous anaesthetic technique using a propofol infusion, with an inhalational technique using enflurane for day case surgery. Anaesthesia 1998;43:84-7.  Back to cited text no. 12
    
13.DiFlorio T. Is propofol a dopamine antagonist? Anesth Analg 1993;77:200-1.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: Postoperative nausea with vomiting and economic analysis. Anesthesiology 2001;95:616-26.  Back to cited text no. 14
[PUBMED]  [FULLTEXT]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]


This article has been cited by
1 Total intravenous versus inhalational anesthesia in endoscopic sinus surgery: A meta-analysis
Victor M. Lu,Kevin Phan,Lawrence J. Oh
The Laryngoscope. 2019;
[Pubmed] | [DOI]
2 Effect of N-methyl-d-aspartate (NMDA) receptor antagonist combination as adjuvant to general anesthesia in functional endoscopic sinus surgery
Karim Youssef Kamal Hakim,Wahba Zakaria Wahba
Ain-Shams Journal of Anesthesiology. 2019; 11(1)
[Pubmed] | [DOI]
3 Postoperative Pain Management Following Craniosynostosis Repair
Stav Brown,Amy Yao,Paymon Sanati-Mehrizy,Sheemon P. Zackai,Peter J. Taub
Journal of Craniofacial Surgery. 2019; 30(3): 721
[Pubmed] | [DOI]
4 Total intravenous anesthesia improves intraoperative visualization during surgery for high-grade chronic rhinosinusitis: a double-blind randomized controlled trial
Jacob P. Brunner,Joshua M. Levy,Melissa L. Ada,Kiranya E. Tipirneni,Henry P. Barham,Gretchen M. Oakley,Daniel R. Cox,Bobby D. Nossaman,Edward D. McCoul
International Forum of Allergy & Rhinology. 2018;
[Pubmed] | [DOI]
5 Total intravenous versus inhaled anesthesia in transsphenoidal tumor surgery
Suneeta Gollapudy,David M. Poetker,Jasmeet Sidhu,Matthias L. Riess
American Journal of Otolaryngology. 2018;
[Pubmed] | [DOI]
6 Obstructive sleep apnoea in adults
Martin Roesslein,Frances Chung
European Journal of Anaesthesiology. 2018; : 1
[Pubmed] | [DOI]
7 The role of intraoperative stroke volume variation on bleeding during functional endoscopic sinus surgery
Roberta Di Mauro,Fabiana Lucci,Federica Martino,Maria B. Silvi,Eleonora Gidaro,Santo Di Lorenzo,Nicola Toschi,Stefano Di Girolamo,Mario Dauri
Minerva Anestesiologica. 2018; 84(11)
[Pubmed] | [DOI]
8 Comparison of dexmedetomidine versus propofol-based anaesthesia for controlled hypotension in functional endoscopic sinus surgery
DK Bharathwaj,SS Kamath
Southern African Journal of Anaesthesia and Analgesia. 2018; : 1
[Pubmed] | [DOI]
9 Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea
Stavros G. Memtsoudis,Crispiana Cozowicz,Mahesh Nagappa,Jean Wong,Girish P. Joshi,David T. Wong,Anthony G. Doufas,Meltem Yilmaz,Mark H. Stein,Megan L. Krajewski,Mandeep Singh,Lukas Pichler,Satya Krishna Ramachandran,Frances Chung
Anesthesia & Analgesia. 2018; 127(4): 967
[Pubmed] | [DOI]
10 Labetalol, nitroglycerin, controlled hypotension, sinus endoscopic surgery
Nagat S. EL-Shmaa,Hoda Alsaid Ahmed Ezz,Ahmed Younes
Journal of Clinical Anesthesia. 2017; 39: 154
[Pubmed] | [DOI]
11 Dexmedetomidine for Sedation During Noninvasive Ventilation in Pediatric Patients*
Rasika Venkatraman,James L. Hungerford,Mark W. Hall,Melissa Moore-Clingenpeel,Joseph D. Tobias
Pediatric Critical Care Medicine. 2017; 18(9): 831
[Pubmed] | [DOI]
12 Controlled Hypotension During Rhinoplasty: A Comparison of Dexmedetomidine With Magnesium Sulfate
Faranak Rokhtabnak,Soudabeh Djalali Motlagh,Mohamadreza Ghodrti,Alireza Pournajafian,Mojtaba Maleki Delarestaghi,Arash Tehrani Banihashemi,Zeinab Araghi
Anesthesiology and Pain Medicine. 2017; In Press(In Press)
[Pubmed] | [DOI]
13 Morbidly obese patients
Frances Chung
Current Opinion in Anaesthesiology. 2016; 29(1): 101
[Pubmed] | [DOI]
14 Does total intravenous anesthesia provide significant blood loss reduction compared to inhalational anesthesia during endoscopic sinus surgery?
Mohammad H. Al-Bar,Jose W. Ruiz,Roy R. Casiano
The Laryngoscope. 2016; : n/a
[Pubmed] | [DOI]
15 Magnesium sulfate or diltiazem as adjuvants to total intravenous anesthesia to reduce blood loss in functional endoscopic sinus surgery
Ajisha Aravindan,Rajeshwari Subramanium,Anjolie Chhabra,Priyankar K. Datta,Vimi Rewari,Suresh.C. Sharma,Rakesh Kumar
Journal of Clinical Anesthesia. 2016; 34: 179
[Pubmed] | [DOI]
16 Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients With Obstructive Sleep Apnea
Frances Chung,Stavros G. Memtsoudis,Satya Krishna Ramachandran,Mahesh Nagappa,Mathias Opperer,Crispiana Cozowicz,Sara Patrawala,David Lam,Anjana Kumar,Girish P. Joshi,John Fleetham,Najib Ayas,Nancy Collop,Anthony G. Doufas,Matthias Eikermann,Marina Englesakis,Bhargavi Gali,Peter Gay,Adrian V. Hernandez,Roop Kaw,Eric J. Kezirian,Atul Malhotra,Babak Mokhlesi,Sairam Parthasarathy,Tracey Stierer,Frank Wappler,David R. Hillman,Dennis Auckley
Anesthesia & Analgesia. 2016; 123(2): 452
[Pubmed] | [DOI]
17 Post-gastrointestinal endoscopy complications in patients with obstructive sleep apnea or at high risk for sleep apnea: a systematic review and meta-analysis
Swarna Gaddam,Sameer K. Gunukula,M. Jeffery Mador
Sleep and Breathing. 2015;
[Pubmed] | [DOI]
18 Hypotensive Anesthesia versus Normotensive Anesthesia during Major Maxillofacial Surgery: A Review of the Literature
Michal Barak,Leiser Yoav,Imad Abu el-Naaj
The Scientific World Journal. 2015; 2015: 1
[Pubmed] | [DOI]
19 Anaesthetic Concerns for Functional Endoscopic Sinus Surgery
Pei Yu Tan,Ruban Poopalalingam
Proceedings of Singapore Healthcare. 2014; 23(3): 246
[Pubmed] | [DOI]
20 Hemostatic effect of hot saline irrigation during functional endoscopic sinus surgery: a randomized controlled trial
Eng Cern Gan,Saad Alsaleh,Jamil Manji,Al-Rahim R. Habib,Ameen Amanian,Amin R. Javer
International Forum of Allergy & Rhinology. 2014; : n/a
[Pubmed] | [DOI]
21 Perioperative Versorgung von Patienten mit obstruktiver Schlafapnoe
Y.A. Zausig,M. Arzt
Der Pneumologe. 2014;
[Pubmed] | [DOI]
22 Sedation in non-invasive ventilation: do we know what to do (and why)?
Dan Longrois,Giorgio Conti,Jean Mantz,Andreas Faltlhauser,Riku Aantaa,Peter Tonner
Multidisciplinary Respiratory Medicine. 2014; 9(1)
[Pubmed] | [DOI]
23 Quality of surgical field during endoscopic sinus surgery: A systematic literature review of the effect of total intravenous compared to inhalational anesthesia
Kelly, E.A. and Gollapudy, S. and Riess, M.L. and Woehlck, H.J. and Loehrl, T.A. and Poetker, D.M.
International Forum of Allergy and Rhinology. 2013; 3(6): 474-481
[Pubmed]
24 Blood loss during endoscopic sinus surgery with propofol or sevoflurane: A randomized clinical trial
Chaaban, M.R. and Baroody, F.M. and Gottlieb, O. and Naclerio, R.M.
JAMA Otolaryngology - Head and Neck Surgery. 2013; 139(5): 510-514
[Pubmed]
25 Evaluating the Efficacy of Remifentanil-Propofol versus Isoflurane in Reducing Blood Loss with Considering Depth of Anesthesia during Endoscopic Sinus Surgery
Mohammad Ali Haghbin,Hossein Hakimzadeh,Mohammad Shabani
Neuroscience & Medicine. 2013; 04(02): 59
[Pubmed] | [DOI]
26 Can systemic lidocaine be used in controlled hypotension? A double-blinded randomized controlled study in patients undergoing functional endoscopic sinus surgery
Ahmed M. Omar
Egyptian Journal of Anaesthesia. 2013; 29(4): 295
[Pubmed] | [DOI]
27 Sedation for interventional gastrointestinal endoscopic procedures: are we overlooking the “pain”?
Seokyung Shin,Sang Kil Lee,Kyung Tae Min,Hyun Ju Kim,Chan Hyuk Park,Young Chul Yoo
Surgical Endoscopy. 2013;
[Pubmed] | [DOI]
28 Control of Bleeding in Endoscopic Skull Base Surgery: Current Concepts to Improve Hemostasis
Cattleya Thongrong,Pornthep Kasemsiri,Ricardo L. Carrau,Sergio D. Bergese
ISRN Surgery. 2013; 2013: 1
[Pubmed] | [DOI]
29 Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia
Elizabeth A. Kelly,Suneeta Gollapudy,Matthias L. Riess,Harvey J. Woehlck,Todd A. Loehrl,David M. Poetker
International Forum of Allergy & Rhinology. 2013; 3(6): 474
[Pubmed] | [DOI]
30 Controlled Hypotension for Functional Endoscopic Sinus Surgery: Comparison of Esmolol and Nitroglycerine
U. Srivastava,A. B. Dupargude,D. Kumar,K. Joshi,A. Gupta
Indian Journal of Otolaryngology and Head & Neck Surgery. 2013; 65(S2): 440
[Pubmed] | [DOI]
31 Systematic review and meta-analysis of total intravenous anesthesia and endoscopic sinus surgery
Adam S. DeConde,Christopher F. Thompson,Edward C. Wu,Jeffrey D. Suh
International Forum of Allergy & Rhinology. 2013; 3(10): 848
[Pubmed] | [DOI]
32 Anesthetic Management of Electrophysiological Procedures for Heart Failure
Tomas Drabek,Jan Nemec
International Anesthesiology Clinics. 2012; 50(3): 22
[Pubmed] | [DOI]
33 Preoperative screening and perioperative care of the patient with sleep-disordered breathing
Dennis Auckley,Norman Bolden
Current Opinion in Pulmonary Medicine. 2012; 18(6): 588
[Pubmed] | [DOI]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Introduction
    Materials and Me...
    Group 1 (Inhalat...
   Group 2 (TIVA)
   Results
   Discussion
   Conclusions
   Acknowledgement
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed6686    
    Printed175    
    Emailed0    
    PDF Downloaded1240    
    Comments [Add]    
    Cited by others 33    

Recommend this journal