[The comparison of the influence of various types of anaesthesia on perioperative bleeding control in endoscopic paranasal sinus surgery].

INTRODUCTION: The study aimed at evaluating the influence of targeted hypotension with three types of anaesthetics on the amount of blood loss in extensive endoscopic operations of polyps of the nose and paranasal sinuses.

MATERIAL AND METHODS: Ninety patients, including 30 women aged 31-73 and 60 men aged 21-79, who were operated within the period of 2008-2010 at Department of Otolaryngology and Laryngological Oncology Military Medical Academy University Clinical Hospital in Lodz, were qualified for the study. The bilateral removal of nasal polyps, bilateral ethmoidectomy, and surgery or revision of the maxillary, sphenoid and temporal sinuses in endoscopy were conducted in each patient. Due to the type of general anaesthesia the patients were divided into three groups, 30 patients each: I – sevoflurane inhalation (sedation) and fentanyl I.V., II – sevoflurane inhalation (sedation) and remifentanil I.V. (analgesia), III – TIVA, propofol sedation and remifentanil analgesia. The drugs were administered via the infusion pomp TCI.

RESULTS: In group I the mean anaesthesia time was 108.67±20.80 min., group II – 112.63±22.17 min., group III – 103.67±17.47 min. The surgery time in the studied groups was as follows: I – 71.33±16.71 min, II – 78.83±24.24 min, III – 66.5±15.49 min. During the operation the mean blood loss was: group I – 365±176.2 ml, group II – 340±150.5 ml, group III – 225±91.7 ml. During the operation the mean rate of blood loss was: group I – 5.118±2.38 ml/min, II – 4.507±2.215 ml/min, group III – 3.416±1.059 ml/min.

CONCLUSIONS: In TIVA the advanced technologically control of a drug dose allows for a better control of hypotension, which, finally, results in lower haemorrhage within the operation area, a favourable condition for both a patient and a physician. Perioperative bleeding was independent on sex in every type of anaesthesia.