Comparison of Total Intravenous Anaesthesia (TIVA) using Propofol and Inhalational Anaesthesia using Isoflurane for controlled Hypotension in Functional Endoscopic Sinus Surgery (FESS)

Saravanan, P A (2007) Comparison of Total Intravenous Anaesthesia (TIVA) using Propofol and Inhalational Anaesthesia using Isoflurane for controlled Hypotension in Functional Endoscopic Sinus Surgery (FESS). Masters thesis, Christian Medical College, Vellore.

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Abstract

INTRODUCTION: 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. However, this surgery can lead to serious complications such as orbital cellulitis, rhino-oral fistulas, lesions to the optic nerve of the duramater and meningitis. These complications are often the result of performing the surgery in the presence of inappropriate bleeding5. Hence to reduce the incidence of complications, it is important to have a surgical field as free of blood as possible to improve visibility. This can be achieved with the use of different anaesthetic techniques to achieve controlled hypotension. The techniques could be based on inhalational anaesthetic or intravenous anaesthetic. Functional endoscopic sinus surgery (FESS) can be performed in some situations solely with local anaesthetics alone. The mechanism of action and the use of Isoflurane towards the achievement of controlled hypotension is well established. Total intravenous anaesthesia (TIVA) with Propofol is a relatively new tool for this purpose and not very widely practiced in India because of the cost. In this study, we propose to compare total intravenous anaesthesia (TIVA) using Propofol versus inhalational anaesthesia using Isoflurane for controlled hypotension in functional endoscopic sinus surgery (FESS). AIM OF THE STUDY: To compare total intravenous anaesthesia (TIVA) using Propofol versus inhalational anaesthesia using Isoflurane for controlled hypotension in functional endoscopic sinus surgery(FESS) with respect to, 1. Ease of achieving and maintaining acceptable blood pressure. 2. Their effect on • Intraoperative blood loss. • Duration of surgery. • Surgeon’s opinion regarding the surgical field. 3. Incidence of complications. PATIENTS AND METHODS: This study was conducted after obtaining approval from the research and ethics committee of this institution.All adults (16-60 years), ASA I patients scheduled for functional endoscopic sinus surgery were eligible to participate in this study. Patients with bleeding disorders and on anticoagulation therapy were excluded. Sample size was calculated as 20 in each group based on the previous studies. During the preoperative evaluation, the study details was explained to all these patients. An informed consent was obtained from all those who volunteered for the study. They were randomly allocated to one of the two groups as per the computerized list prepared before the start of the study. All the patients were premedicated with tablet Diazepam 0.2 mg/kg 1 hour prior to the induction of anaesthesia. On arrival to the operating room, an intravenous cannula was inserted into the forearm and monitoring that included pulse oximeter (Spo2), noninvasive blood pressure (NIBP), electrocardiogram(ECG), end tidal carbondioxide (ETCO2) and end tidal Isoflurane analyzer was established. Statistical Analysis: Statistical analysis was done by using descriptive statistics and cross tabulation.Mean and standard deviation were used to assess changes within and between the two groups.A p value of <0.05 was considered to be statistically significant. CONCLUSION: 1. Controlled hypotension can be achieved equally effectively using inhalational anaesthesia with isoflurane as well as total intravenous anaesthesia (TIVA) using propofol. 2. Total intravenous anaesthesia (TIVA) using propofol offers no significant advantage over the conventionally used inhalational anaesthetic technique using isoflurane in terms of operative conditions and intraoperative blood loss.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Total Intravenous Anaesthesia (TIVA) ; Propofol ; Inhalational Anaesthesia ; Isoflurane ; Hypotension ; Functional Endoscopic Sinus Surgery (FESS) ; Comparison study.
Subjects: MEDICAL > Anaesthesiology
Depositing User: Subramani R
Date Deposited: 30 Apr 2018 02:52
Last Modified: 30 Apr 2018 02:52
URI: http://repository-tnmgrmu.ac.in/id/eprint/7310

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