Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial

Background Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggestin...

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Veröffentlicht in:International forum of allergy & rhinology 2018-10, Vol.8 (10), p.1114-1122
Hauptverfasser: Brunner, Jacob P., Levy, Joshua M., Ada, Melissa L., Tipirneni, Kiranya E., Barham, Henry P., Oakley, Gretchen M., Cox, Daniel R., Nossaman, Bobby D., McCoul, Edward D.
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container_end_page 1122
container_issue 10
container_start_page 1114
container_title International forum of allergy & rhinology
container_volume 8
creator Brunner, Jacob P.
Levy, Joshua M.
Ada, Melissa L.
Tipirneni, Kiranya E.
Barham, Henry P.
Oakley, Gretchen M.
Cox, Daniel R.
Nossaman, Bobby D.
McCoul, Edward D.
description Background Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggesting a role for TIVA in that disease subgroup. Methods A double‐blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high‐grade CRS defined as either sinonasal polyposis or a preoperative Lund‐Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10‐point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4‐3.9] vs IA 4.1[3.0‐5.8], p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100‐450] vs 300 mL [200‐500], p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT‐22 scores at 3 months (p = 0.278) and at 6 months (p = 0.396) following ESS. Conclusion TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high‐grade inflammatory sinus disease.
doi_str_mv 10.1002/alr.22173
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Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggesting a role for TIVA in that disease subgroup. Methods A double‐blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high‐grade CRS defined as either sinonasal polyposis or a preoperative Lund‐Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10‐point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4‐3.9] vs IA 4.1[3.0‐5.8], p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100‐450] vs 300 mL [200‐500], p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT‐22 scores at 3 months (p = 0.278) and at 6 months (p = 0.396) following ESS. Conclusion TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high‐grade inflammatory sinus disease.</description><identifier>ISSN: 2042-6976</identifier><identifier>EISSN: 2042-6984</identifier><identifier>DOI: 10.1002/alr.22173</identifier><identifier>PMID: 29979837</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Anesthesia ; Blood ; chronic rhinosinusitis ; Clinical trials ; Double-blind studies ; endoscopic sinus surgery ; Inflammatory diseases ; intraoperative visualization ; Intravenous administration ; Lund‐Mackay ; Mucosa ; nasal polyposis ; Polyposis ; Quality of life ; Rhinitis ; Rhinosinusitis ; Sino‐Nasal Outcome Test ; Sinusitis ; Surgery ; total intravenous anesthesia ; Visual field ; Visualization</subject><ispartof>International forum of allergy &amp; rhinology, 2018-10, Vol.8 (10), p.1114-1122</ispartof><rights>2018 ARS‐AAOA, LLC</rights><rights>2018 ARS-AAOA, LLC.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4103-6375073b4b528c1ec1e8c4f6adfd6a1630286fc519f32a41ec237b6cb5d735343</citedby><cites>FETCH-LOGICAL-c4103-6375073b4b528c1ec1e8c4f6adfd6a1630286fc519f32a41ec237b6cb5d735343</cites><orcidid>0000-0001-5907-3421 ; 0000-0003-1812-2105</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Falr.22173$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Falr.22173$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1416,27923,27924,45573,45574</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29979837$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brunner, Jacob P.</creatorcontrib><creatorcontrib>Levy, Joshua M.</creatorcontrib><creatorcontrib>Ada, Melissa L.</creatorcontrib><creatorcontrib>Tipirneni, Kiranya E.</creatorcontrib><creatorcontrib>Barham, Henry P.</creatorcontrib><creatorcontrib>Oakley, Gretchen M.</creatorcontrib><creatorcontrib>Cox, Daniel R.</creatorcontrib><creatorcontrib>Nossaman, Bobby D.</creatorcontrib><creatorcontrib>McCoul, Edward D.</creatorcontrib><title>Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial</title><title>International forum of allergy &amp; rhinology</title><addtitle>Int Forum Allergy Rhinol</addtitle><description>Background Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggesting a role for TIVA in that disease subgroup. Methods A double‐blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high‐grade CRS defined as either sinonasal polyposis or a preoperative Lund‐Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10‐point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4‐3.9] vs IA 4.1[3.0‐5.8], p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100‐450] vs 300 mL [200‐500], p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT‐22 scores at 3 months (p = 0.278) and at 6 months (p = 0.396) following ESS. Conclusion TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high‐grade inflammatory sinus disease.</description><subject>Anesthesia</subject><subject>Blood</subject><subject>chronic rhinosinusitis</subject><subject>Clinical trials</subject><subject>Double-blind studies</subject><subject>endoscopic sinus surgery</subject><subject>Inflammatory diseases</subject><subject>intraoperative visualization</subject><subject>Intravenous administration</subject><subject>Lund‐Mackay</subject><subject>Mucosa</subject><subject>nasal polyposis</subject><subject>Polyposis</subject><subject>Quality of life</subject><subject>Rhinitis</subject><subject>Rhinosinusitis</subject><subject>Sino‐Nasal Outcome Test</subject><subject>Sinusitis</subject><subject>Surgery</subject><subject>total intravenous anesthesia</subject><subject>Visual field</subject><subject>Visualization</subject><issn>2042-6976</issn><issn>2042-6984</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kc9q3DAQxk1paEKaQ1-gCHrqYRP9sSW7h0IIbVNYKITkLGRJtidopa1kO2xOfYS-Rd-rT1IlTpf2EDGgEfPjm9F8RfGG4FOCMT1TLp5SSgR7URxRXNIVb-ry5T4X_LA4SekW51ORqiLiVXFIm0Y0NRNHxa_rMCqHwI9RzdaHKSHlbRoHm0Ah2GxjmG1a6mFroxphtmiGNCkH9_kVPDJTBN-jNMXexh3qQkQD9MPvHz_7qIxFeojBg0ZxAB8S-CnBCOkDUsiEqXU2g60Db1BU3oQN3FuDdMgdg3M5HSMo97o46JRL9uTpPi5uPn-6vrhcrb99-Xpxvl7pkmC24kxUWLC2bCtaa2Jz1LrsuDKd4YpwhmnNO12RpmNUlRmgTLRct5URrGIlOy4-Lrrbqd1Yo-3Dx53cRtiouJNBgfy_4mGQfZglLxnjlGSBd08CMXyf8iblbZiizzNLSkhZC4pZnan3C6VjSCnabt-BYPlgq8y2ykdbM_v235H25F8TM3C2AHfg7O55JXm-vlok_wDRZrS6</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Brunner, Jacob P.</creator><creator>Levy, Joshua M.</creator><creator>Ada, Melissa L.</creator><creator>Tipirneni, Kiranya E.</creator><creator>Barham, Henry P.</creator><creator>Oakley, Gretchen M.</creator><creator>Cox, Daniel R.</creator><creator>Nossaman, Bobby D.</creator><creator>McCoul, Edward D.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5907-3421</orcidid><orcidid>https://orcid.org/0000-0003-1812-2105</orcidid></search><sort><creationdate>201810</creationdate><title>Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial</title><author>Brunner, Jacob P. ; Levy, Joshua M. ; Ada, Melissa L. ; Tipirneni, Kiranya E. ; Barham, Henry P. ; Oakley, Gretchen M. ; Cox, Daniel R. ; Nossaman, Bobby D. ; McCoul, Edward D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4103-6375073b4b528c1ec1e8c4f6adfd6a1630286fc519f32a41ec237b6cb5d735343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Anesthesia</topic><topic>Blood</topic><topic>chronic rhinosinusitis</topic><topic>Clinical trials</topic><topic>Double-blind studies</topic><topic>endoscopic sinus surgery</topic><topic>Inflammatory diseases</topic><topic>intraoperative visualization</topic><topic>Intravenous administration</topic><topic>Lund‐Mackay</topic><topic>Mucosa</topic><topic>nasal polyposis</topic><topic>Polyposis</topic><topic>Quality of life</topic><topic>Rhinitis</topic><topic>Rhinosinusitis</topic><topic>Sino‐Nasal Outcome Test</topic><topic>Sinusitis</topic><topic>Surgery</topic><topic>total intravenous anesthesia</topic><topic>Visual field</topic><topic>Visualization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brunner, Jacob P.</creatorcontrib><creatorcontrib>Levy, Joshua M.</creatorcontrib><creatorcontrib>Ada, Melissa L.</creatorcontrib><creatorcontrib>Tipirneni, Kiranya E.</creatorcontrib><creatorcontrib>Barham, Henry P.</creatorcontrib><creatorcontrib>Oakley, Gretchen M.</creatorcontrib><creatorcontrib>Cox, Daniel R.</creatorcontrib><creatorcontrib>Nossaman, Bobby D.</creatorcontrib><creatorcontrib>McCoul, Edward D.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>International forum of allergy &amp; rhinology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brunner, Jacob P.</au><au>Levy, Joshua M.</au><au>Ada, Melissa L.</au><au>Tipirneni, Kiranya E.</au><au>Barham, Henry P.</au><au>Oakley, Gretchen M.</au><au>Cox, Daniel R.</au><au>Nossaman, Bobby D.</au><au>McCoul, Edward D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial</atitle><jtitle>International forum of allergy &amp; rhinology</jtitle><addtitle>Int Forum Allergy Rhinol</addtitle><date>2018-10</date><risdate>2018</risdate><volume>8</volume><issue>10</issue><spage>1114</spage><epage>1122</epage><pages>1114-1122</pages><issn>2042-6976</issn><eissn>2042-6984</eissn><abstract>Background Total intravenous anesthesia (TIVA) has been proposed as a method to reduce blood loss during endoscopic sinus surgery (ESS). Impaired sinonasal visualization due to mucosal bleeding may be burdensome in cases of chronic rhinosinusitis (CRS) with high‐grade inflammatory disease, suggesting a role for TIVA in that disease subgroup. Methods A double‐blind, randomized controlled trial was conducted of adults undergoing ESS at a tertiary medical center. Patients considered for inclusion had high‐grade CRS defined as either sinonasal polyposis or a preoperative Lund‐Mackay score of ≥12. Subjects were randomized to receive either TIVA or inhaled anesthesia (IA) during ESS. The primary outcome measure was intraoperative visibility as rated by 3 blinded reviewers utilizing the 10‐point Wormald Surgical Field Grading Scale. Secondary outcomes included operative blood loss, complications, and change in quality of life evaluated by the 22‐item Sino‐Nasal Outcome Test (SNOT‐22). Results A total of 72 patients were randomized into TIVA (n = 37) and IA (n = 35) study arms. Aggregate median (interquartile range) Wormald scores across all reviewers demonstrated a more favorable visual field with TIVA compared to IA (3.5 [2.4‐3.9] vs IA 4.1[3.0‐5.8], p = 0.0089). There was significantly less blood loss in the TIVA group compared to the IA group (200 mL [100‐450] vs 300 mL [200‐500], p = 0.046). Baseline patient characteristics were comparable between cohorts with no significant postoperative complications. No significant changes were detected between postoperative SNOT‐22 scores at 3 months (p = 0.278) and at 6 months (p = 0.396) following ESS. Conclusion TIVA contributes to improved intraoperative visualization and decreased blood loss in patients undergoing ESS for high‐grade inflammatory sinus disease.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>29979837</pmid><doi>10.1002/alr.22173</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-5907-3421</orcidid><orcidid>https://orcid.org/0000-0003-1812-2105</orcidid><oa>free_for_read</oa></addata></record>
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subjects Anesthesia
Blood
chronic rhinosinusitis
Clinical trials
Double-blind studies
endoscopic sinus surgery
Inflammatory diseases
intraoperative visualization
Intravenous administration
Lund‐Mackay
Mucosa
nasal polyposis
Polyposis
Quality of life
Rhinitis
Rhinosinusitis
Sino‐Nasal Outcome Test
Sinusitis
Surgery
total intravenous anesthesia
Visual field
Visualization
title Total intravenous anesthesia improves intraoperative visualization during surgery for high‐grade chronic rhinosinusitis: a double‐blind randomized controlled trial
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