Total Intravenous Anesthesia Versus Inhaled Sevoflurane in Obstructive Sleep Apnea Surgery: A Randomized Controlled Trial.
hypoglossal nerve stimulation
inhalational anesthesia
obstructive sleep apnea
recovery time
total intravenous anesthesia
Journal
The Laryngoscope
ISSN: 1531-4995
Titre abrégé: Laryngoscope
Pays: United States
ID NLM: 8607378
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
revised:
23
09
2022
received:
02
06
2022
accepted:
24
09
2022
pubmed:
15
10
2022
medline:
17
3
2023
entrez:
14
10
2022
Statut:
ppublish
Résumé
Specific guidelines regarding an optimal general anesthesia (GA) approach to obstructive sleep apnea (OSA) patients remain undefined. Literature comparing the efficacy of total intravenous anesthesia (TIVA) and inhalational anesthesia in this population is sparse. We hypothesize that OSA patients receiving TIVA will experience reduced recovery times and other improved post-surgical outcomes. Randomized controlled trial. Adult OSA patients undergoing upper airway surgery (hypoglossal nerve stimulation [HNS], nasal, or palate surgery) from February 2020-December 2020 were included. A post-anesthesia care unit (PACU) nursing survey documented patients' alertness, pain, oxygen supplementation, and postoperative nausea and vomiting from PACU arrival to 2 hours. Perioperative timepoints from the electronic medical record (EMR) and a nurse-estimated Phase I recovery time were collected. One hundred eleven patients were included (46 TIVA and 65 inhalational anesthesia). Per EMR-recorded timepoints, TIVA patients undergoing HNS and palate surgery experienced Phase I Time reductions of 12.5 min (p = 0.042) and 27.5 min (p = 0.016), respectively. Per the PACU survey, TIVA patients undergoing any surgery, HNS, or palate surgery experienced nurse-estimated Phase I Time reductions of 16.5 min (p = 0.004), 12.5 min (p = 0.031), and 38.5 min (p = 0.024), respectively. Overall, TIVA patients experienced higher alertness and pain ratings, and lower oxygen supplementation requirements from PACU arrival to 30 min (p < 0.05). Patients with OSA receiving TIVA for GA maintenance during upper airway procedures experienced reduced recovery times and oxygen supplementation requirements, and a more rapid return to alertness. Future work toward developing optimized anesthetic guidelines for OSA patients is merited. 3 Laryngoscope, 133:984-992, 2023.
Substances chimiques
Sevoflurane
38LVP0K73A
Propofol
YI7VU623SF
Anesthetics, Intravenous
0
Anesthetics, Inhalation
0
Types de publication
Randomized Controlled Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
984-992Informations de copyright
© 2022 The American Laryngological, Rhinological and Otological Society, Inc.
Références
Ralls F, Cutchen L. A contemporary review of obstructive sleep apnea. Curr Opin Pulm Med. 2019;25:578-593.
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM. Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol. 2013;177:1006-1014.
Rotenberg BW, Murariu D, Pang KP. Trends in CPAP adherence over twenty years of data collection: a flattened curve. J Otolaryngol Head Neck Surg. 2016;45:43.
Gottlieb DJ, Punjabi NM. Diagnosis and management of obstructive sleep apnea: a review. JAMA. 2020;323:1389-1400.
Ravesloot MJL, de Raaff CAL, Van de Beek MJ, et al. Perioperative care of patients with obstructive sleep apnea undergoing upper airway surgery: a review and consensus recommendations. JAMA Otolaryngol Head Neck Surg. 2019;145:751-760.
Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on perioperative management of patients with obstructive sleep apnea. Anesthesiology. 2014;120:268-286.
Smith G, D'Cruz JR, Rondeau B, Goldman J. General Anesthesia for Surgeons StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2022, StatPearls Publishing LLC; 2022.
Malhotra R, Kumar N, Jain A. Cost identification analysis of general anesthesia. J Anaesthesiol Clin Pharmacol. 2020;36:219-226.
Schraag S, Pradelli L, AJO A, et al. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. BMC Anesthesiol. 2018;18(162):162.
Kumar G, Stendall C, Mistry R, Gurusamy K, Walker D. A comparison of total intravenous anaesthesia using propofol with sevoflurane or desflurane in ambulatory surgery: systematic review and meta-analysis. Anaesthesia. 2014;69:1138-1150.
Eikaas H, Raeder J. Total intravenous anaesthesia techniques for ambulatory surgery. Curr Opin Anaesthesiol. 2009;22:725-729.
Stewart M, Estephan L, Thaler A, et al. Reduced recovery times with total intravenous anesthesia in patients with obstructive sleep apnea. Laryngoscope. 2021;131:925-931.
Palumbo P, Tellan G, Perotti B, Pacilè MA, Vietri F, Illuminati G. Modified PADSS (post Anaesthetic discharge scoring system) for monitoring outpatients discharge. Ann Ital Chir. 2013;84:661-665.
Team RC. R: a language and environment for statistical computing. R Foundation for Statistical Computing. Available at: https://www.R-project.org/.
Prism G. GraphPad Prism version 9.0.2 (134) for macOS 2021.
Nimmo AF, Absalom AR, Bagshaw O, et al. Guidelines for the safe practice of total intravenous anaesthesia (TIVA): joint guidelines from the Association of Anaesthetists and the Society for Intravenous Anaesthesia. Anaesthesia. 2019;74:211-224.
Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anesthesia with propofol versus inhalation anesthesia with isoflurane-nitrous oxide: postoperative nausea with vomiting and economic analysis. Anesthesiology. 2001;95:616-626.
Miller TE, Gan TJ. Total intravenous anesthesia and anesthetic outcomes. J Cardiothorac Vasc Anesth. 2015;29(Suppl 1):S11-S15.
Jo JY, Jung KW, Kim HJ, et al. Effect of Total intravenous anesthesia vs volatile induction with maintenance anesthesia on emergence agitation after nasal surgery: a randomized clinical trial. JAMA Otolaryngol Head Neck Surg. 2019;145:117-123.
Gan TJ, Habib AS, Miller TE, White W, Apfelbaum JL. Incidence, patient satisfaction, and perceptions of post-surgical pain: results from a US national survey. Curr Med Res Opin. 2014;30:149-160.
Jo JY, Kim YJ, Choi SS, Park J, Park H, Hahm KD. A prospective randomized comparison of postoperative pain and complications after thyroidectomy under different anesthetic techniques: volatile anesthesia versus total intravenous anesthesia. Pain Res Manag. 2021;2021:8876906.
Mukherjee K, Seavell C, Rawlings E, Weiss A. A comparison of total intravenous with balanced anaesthesia for middle ear surgery: effects on postoperative nausea and vomiting, pain, and conditions of surgery. Anaesthesia. 2003;58:176-180.
Chokshi T, Channabasappa S, Vergheese DC, Bajwa SJS, Gupta B, Mehdiratta L. Re-emergence of TIVA in COVID times. Indian J Anaesth. 2020;64:S125-S131.
Hohlrieder M, Tiefenthaler W, Klaus H, et al. Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia. Br J Anaesth. 2007;99:587-591.
Chang YT, Wu CC, Tang TY, Lu CT, Lai CS, Shen CH. Differences between total intravenous anesthesia and inhalation anesthesia in free flap surgery of head and neck cancer. PLoS One. 2016;11:e0147713.
Smith I. Total intravenous anaesthesia: is it worth the cost? CNS Drugs. 2003;17:609-619.
Alnemri A, Sussman S, Estephan L, et al. Cost of total intravenous anesthesia versus inhalation anesthesia in obstructive sleep apnea surgery. Laryngoscope. 2022;132:1487-1494.
Rosow C, Manberg PJ. Bispectral index monitoring. Anesthesiol Clin North Am. 2001;19:947-966, xi, 966.