Comparison of surgical field - sevoflurane versus propofol based anaesthesia in functional endoscopic sinus surgery
Journal Title: Medpulse International Journal of Anesthesiology - Year 2018, Vol 7, Issue 2
Abstract
Background: Functional endoscopic sinus surgery requires a bloodless surgical field in order to facilitate the ease and thoroughness of the surgery to produce good surgical results without complication. Aim: To ompare sevoflurane with propofol based anaesthesia with respect to blood loss, surgical field visibility, aemodynamics and duration of surgery. Materials and methods: This randomized clinical study took place in a government-run teaching hospital in South India. Fifty ASA I or II patients aged between 18 and 60 years with chronic rhinosinusitis were randomly assigned to either of the two groups- Group 1-sevoflurane (n=25), Group 2-propofol (n=25). After induction with fentanyl 2 mcg/kg, propofol 2.5 mg/kg and rocuronium 0.6 mg/kg, anaesthesia was maintained in Group 1 with nitrous oxide and oxygen 2:1 , sevoflurane 2 – 2.5% and in Group 2 with nitrous oxide and oxygen 2:1, propofol 10 mg/kg/hr for first ten minutes, 8 mg/kg/hr for next ten minutes followed by 6 mg/kg/hr. All patients received 0.5mcg/kg fentanyl bolus every thirty minutes. Target mean arterial pressure (MAP) was 60 to 70 mm Hg. If MAP was greater, titrated nitroglycerine infusion was used and if lesser, fluid bolus followed by ephedrine boluses were given. Blood loss was measured by subtracting the irrigation fluid from the blood collected in the suction canister and adding blood soaked in gauze. At the end of the surgery, the surgeon blinded to the anaesthetic technique assessed the surgical field based on Fromme-Boezaart scale. Statistical analysis was done using SPSS. Categorical data was analysed using chi-square test and continuous data using student t-test. p < 0.05 was considered significant. Results: The blood loss was 157±91 ml in the sevoflurane group and 102±59 ml in the propofol group (p = 0.024). One (4%) patient in the sevoflurane group and twenty one (84%) patients in the propofol group were scored 1 in the Fromme-Boezaart scale (p < 0.01).The remaining patients scored 2 in the scale (p < 0.01). The traoperative mean heart rate in the sevoflurane group was 78±4 bpm and 69±5 bpm in the propofol group (p < 0.01). MAP and duration of surgery were comparable between the two groups. Conclusion: Though propofol causes lesser bleeding and better scores in the surgical field visibility , it is not significant in a clinically relevant manner. Thus propofol based anaesthesia is not better than sevoflurane based anaesthesia in providing good surgical field.
Authors and Affiliations
Merlin Shalini Ruth
Keywords
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