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Original Article |

Blood Loss During Endoscopic Sinus Surgery With Propofol or Sevoflurane:  A Randomized Clinical Trial

Mohamad R. Chaaban, MD; Fuad M. Baroody, MD; Ori Gottlieb, MD; Robert M. Naclerio, MD
JAMA Otolaryngol Head Neck Surg. 2013;139(5):510-514. doi:10.1001/jamaoto.2013.2885.
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Importance Total intravenous anesthesia (TIVA) with propofol has been associated with reduced operative time, decreased perioperative risks, and decreased intraoperative blood loss compared with inhalational anesthesia (IA). During endoscopic sinus surgery (ESS), reduced bleeding from the mucosal surfaces could improve visualization of the anatomy and decrease the risk of serious complications.

Objective To compare blood loss during ESS between patients receiving TIVA with propofol and those receiving IA with sevoflurane.

Design, Setting, and Participants Prospective, randomized study of 33 patients undergoing ESS in an academic medical center.

Interventions Patients received either TIVA or IA.

Main Outcomes and Measures The primary outcome was rate of blood loss in milliliters per hour. The secondary outcomes included the quality of visibility measured by the surgeon's numeric rating score, ease of anesthesia as measured by the anesthesiologist's numeric rating score, and total blood loss.

Results The mean (SEM) blood loss per hour in the TIVA group was 78.5 (14) mL/h, and in the IA group it was 80.3 (17) mL/h (P = .93). A post hoc subgroup analysis found that in patients with a Lund-Mackay score of 12 or lower, the propofol TIVA group had a lower rate of blood loss compared with the sevoflurane IA group (mean blood loss, approximately 18 mL/h vs approximately 99 mL/h). The anesthesiologist's numeric rating score was significantly higher (indicating greater ease of performance) in the IA group than in the TIVA group. There was no statistically significant difference in the surgical numeric rating score between the 2 groups.

Conclusions and Relevance In this comparative study, our results did not show any difference in blood loss and surgical conditions between the TIVA and IA groups. Even further study is not likely to show a difference in blood loss between TIVA and IA during ESS.

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Figure. Comparison of mean estimated blood loss (EBL) in patients stratified according to severity of disease as measured by Lund-Mackay (LM) scores. A, Patients with LM scores of 12 or lower. B, Patients with LM scores higher than 12. IA indicates inhalation anesthesia; TIVA, total intravenous anesthesia; error bars represent standard deviations.

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