Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia.
Quality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia.
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内窥镜鼻窦手术期间手术场的质量：与吸入麻醉相比，对总静脉内作用的系统文献综述。
DOI：
10.1002/alr.21125
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发表时间：
2013-06
影响因子：
6.4
通讯作者：
Poetker, David M.
中科院分区：
文献类型：
--
作者：
Kelly, Elizabeth A.;Gollapudy, Suneeta;Riess, Matthias L.;Woehlck, Harvey J.;Loehrl, Todd A.;Poetker, David M.
充分的手术视野可视化是内镜鼻窦手术（ESS）成功的必要条件。麻醉的类型可以改变患者的血流动力学和影响手术期间的内镜可视化。我们回顾了目前关于全静脉麻醉（TIVA）与吸入麻醉（INA）对ESS手术视野可视化影响的证据。对文献进行了系统的回顾。检索了1946年至2012年1月的Ovid MEDLINE、Scopus和Cochrane数据库。对主要检索的引文进行审查和筛选，以确定所有相关的英文摘要。值得全面回顾的文章包括前瞻性对照试验，纳入接受ESS的成年患者，随机分为接受INA或TIVA的组，结果测量侧重于手术视野可视化。7项试验符合纳入标准。七篇文章中的四篇表明，与INA相比，接受TIVA时ESS手术野区等级有统计学意义的改善。然而，通常没有提供详细的INA浓度。可能已经给药了高水平的INA；因此，可能代表的是INA的副作用，而不是理想的INA给药效果。麻醉组之间的镇痛给药也有很大差异，这进一步使研究结果的解释复杂化。由于缺乏有效性和研究的异质性，无法进行正式的荟萃分析。虽然一些研究报道了TIVA改善ESS的手术条件，但是存在明显的局限性。这些发现在这一点上阻止了任何明确的建议，强调需要进一步的高质量研究。
Adequate surgical field visualization is imperative for successful outcomes in endoscopic sinus surgery (ESS). The type of anesthetic administered can alter a patient’s hemodynamics and impact endoscopic visualization during surgery. We review the current evidence regarding the effect of total intravenous anesthesia (TIVA) compared to inhalational anesthesia (INA) on visualization of the surgical field during ESS. A systematic review of the literature was performed. Ovid MEDLINE, Scopus, and Cochrane databases were searched from 1946 to January 2012. Citations from the primary search were reviewed and filtered to identify all relevant abstracts in English. Articles meriting full review included prospective controlled trials enrolling adult patients undergoing ESS that were randomized to a group receiving INA or TIVA with outcome measures focused on surgical field visualization. Seven eligible trials fulfilled inclusion criteria. Four of the seven articles demonstrated a statistically significant improvement in surgical field grade during ESS when receiving TIVA compared with INA. However, detailed INA concentrations were often not provided. High levels of INA may have been administered; therefore, side effects of INA rather than effects of an ideal INA administration were possibly represented. Analgesic administration also varied widely among the anesthetic groups further complicating interpretation of study results. The lack of power and the heterogeneity of the studies precluded a formal meta-analysis. Although several studies reported that TIVA improve surgical conditions in ESS, however there are significant limitations. These findings prevent any definite recommendation at this point, emphasizing the need for further high quality studies.
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