Propofol versus sevoflurane: Bleeding in endoscopic sinus surgery

Reduction of intraoperative bleeding is desirable to improve intraoperative visibility and to avoid complications. Prospective, controlled, randomized, double-blinded study. Inclusion criteria were chronic rhinosinusitis with nasal polyps that involved all paranasal sinuses, Lund-CT score ≥12, and double-blind preoperative randomization of narcotics. Exclusion criteria included abnormal coagulation, perioperative blood pressure outside the range of 70 to 140 mmHg systolic and 50 to 90 mmHg diastolic and perioperative medication. Total blood loss (mL), blood loss per minute (mL/min), platelet function, and parameter for endoscopic vision were evaluated. Forty-six patients (22 sedated with sevoflurane/fentanyl, 24 sedated with propofol/fentanyl) completed the study. Total blood loss (300.1 ± 168.5 mL/276.9 ± 201.3 mL), blood loss per minute, and endoscopic vision showed no group difference. Platelet function was significantly impaired 45 minutes after onset of surgery in both groups, but more pronounced after propofol anesthesia. Under conditions of balanced circulatory parameter, equal blood loss and endoscopic vision can be achieved with both tested anesthetic regimens. During extended operations demonstrated thrombocyte impairment by propofol may become clinically relevant.