Comparative evaluation of anaesthesia methods for endoscopic rhinosinus surgical interventions

The objective was to analyze different methods of anesthesia for endoscopic rhinosinus surgical interventions and to identify the optimal one.

Methods and materials. In a single-center retrospective-prospective study (967 patients), three variants of local anesthesia were evaluated in the form of application + infiltration anesthesia of the nasal cavity with the addition of: 1) intranasal blockade of the pterygopalatine ganglion, n=20; 2) intramuscular administration of benzodiazepines and narcotic analgesics, n=60; 3) intravenous administration of propofol and dexmedetomidine, n=60, as well as the option of total intravenous (n=60) and general combined anesthesia with mechanical ventilation (n=767). Evaluation criteria: hemodynamic and gas exchange (MAP, systolic BP, perfusion index (PI), PetCO2), wound bleeding intensity, patient’s qualitative assessment of anesthesia using the QoR-15 scale. The concentration of IL-6, IL-10, IL-18, alpha1-antitrypsin, and ferritin in the blood was studied in 26 patients.

Results. Local anesthesia methods were rated negatively by patients and surgeons in more than half of cases. Almost 40 % of patients considered the quality of general anesthesia as excellent, the rest considered good or satisfactory, and only 1.6 % considered it as poor. MAP, systolic BP, MAC of the anesthetic, PetCO2 affect bleeding in the surgical area. Optimal values of PI, as an integral criterion of the perfusion state, are in the range from 6.1 to 8.83 %. Exceeding these values is fraught with the development of significant bleeding. The use of a laryngeal mask is safe, moreover, its use instead of tracheal intubation helps to reduce bleeding in the wound.

Conclusion. Endoscopic interventions lasting longer than 60 min are preferably performed under general combined anesthesia with artificial ventilation and maintenance of airway patency using a laryngeal mask. Such anesthesia ensures hemodynamic stability and gas exchange, and allows for the control of the degree of bleeding by selecting the values of the factors influencing it.

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