Systematic review and meta-analysis of total intravenous anesthesia and endoscopic sinus surgery

Background: Total intravenous anesthesia (TIVA) has been shown in some studies to impact visual field, blood loss, and cardiovascular parameters during endoscopic sinus surgery when compared to inhalational anesthesia (IA). These variables are critical in endoscopic sinus surgery. A systematic review and meta-analysis was undertaken to discern the impact of TIVA vs IA in endoscopic sinus surgery. Methods: MEDLINE (1950 to October 20, 2012) was searched using a search strategy designed to include all randomized controlled trials (RCTs) that discussed TIVA, IA, and endoscopic sinus surgery. An abstract search was then used to identify RCTs directly comparing TIVA and IA in endoscopic sinus surgery. All articles selected then underwent full-text review. Data on visual field scores, blood loss, and cardiovascular parameters was then extracted, compared, and analyzed. Results: There were 42 articles identified by the search strategy. Full-text review identified 9 articles that met eligibility criteria and contained extractable data. Although inconsistently reported, preoperative characteristics (Lund-Mackay scores and history of nasal polyps) were similar (p > 0.05) between the 2 groups. No difference was found between heart rate, mean arterial pressure, anesthesia time, operative time, or estimated blood loss. Only 7 studies reported a visibility score, but overall favored the TIVA group (p < 0.001). Conclusion: Current evidence supporting TIVA is limited to a handful of inconsistently controlled and reported studies. Standardized grading of visibility scores and preoperative characteristics would better establish the role of TIVA in endoscopic sinus surgery.