Surgeon satisfaction during endoscopic management of cerebrospinal fluid rhinorrhea: a comparison between propofol-remifentanil and isoflurane-remifentanil anesthesia

ABSTRACT

Surgeon's depend to a large degree on the amount of blood loss and a clear view of the surgical field, when conducting endoscopic procedures in order to achieve satisfactory outcomes. The anesthesiologist's choice of method for the induction and maintenance of anesthesia plays a major role in achieving this goal. This study was performed in order to compare the two most well-known methods in this regard; total intravenous anesthesia [TIVA] and venous inhalational mixed anesthesia [VIMA]. This study included the endoscopic management of 89 patients with cerebrospinal leakage [CSF leakage] covering a period of nine years [1999-2008] for whom a subarachnoid injection of fluorescein was first administered, and afterwards they were maintained under general anesthesia using two distinct methods; propofol-remifentanil versus isoflurane-remifentanil [inhalational or intravenous]. During the operation, hemodynamic indices, blood loss, and surgeon's satisfaction, were assessed and compared between the two groups. Endoscopic management and autografts were successful in repairing anterior skull defects in 90% of cases. Regarding the surgeon's satisfaction level, and hemodynamic stability no significant difference between the two groups was observed [P > 0.01]. Both isoflurane and propofol in combination with remifentanil afford optimal surgical conditions with regard to hemodynamic parameters and the satisfaction of the surgeon with the surgical field