Controlled hypotension during endoscopic transnasal operations in neurosurgery: which anesthetic technique is most suitable
Bulgarian Medical Journal, 2024, 18(2), 38-42.
D. Monov1, N. Lilyanov1, D. Nikolakov2
1 Department of Anesthesiology and Intensive Care Unit, UH “Sv. Ivan Rilski” ‒ Sofia
2 UMHAT “Sv. Anna” ‒ Sofia
Abstract. The primary objective of functional endoscopy in neurosurgery is to restore drainage and aeration of the paranasal sinuses, along with conducting operative interventions for pituitary tumors. Simultaneously, it aims to maintain the natural mechanism of mucociliary clearance and preserve normal anatomical structures. Nevertheless, this surgical procedure can lead to complications, including orbital cellulitis, rhino-oral fistulas, and optic nerve damage. Maintaining a clear surgical field is crucial to reduce the risk of complications. General anesthesia is frequently favored over local anesthesia due to the discomfort and intense pain stimulation associated with the procedure. Furthermore, general anesthesia facilitates the attainment of hypotensive anesthesia. Controlled hypotension is essential in endoscopic procedures in neurosurgery to improve visualization and minimize operative time and blood loss. Various agents such as beta-blockers, alpha and beta blockers, alpha agonists, vasodilators, and magnesium sulfate have been used to achieve controlled hypotension. The technique of inhalation anesthesia based on sevoflurane to achieve controlled hypotension has become widely popular. Additionally, Total intravenous anesthesia (TIVA) with propofol and remifentanil is common practice. The objective of this retrospective study was to compare total intravenous anesthesia using propofol and inhalation anesthesia using sevoflurane for achieving controlled hypotension in functional endoscopic sinus neurosurgery.
Key words: anesthetic techniques, controlled hypotension, sevoflurane, endoscopic operations in neurosurgery, propofol
Address for correspondence: Dr. Dimitar Monov, MD, UMHAT “Sv. Ivan Rilski”, 15 “Acad. Ivan Geshov” Blvd., Sofia,
e-mail: d_monov@abv.bg