xRead - Nasal Obstruction (September 2024) Full Articles

20426984, 2021, 3, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22741 by Stanford University, Wiley Online Library on [01/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

548

International consensus statement on rhinosinusitis

(Continues)

Middle cerebral artery blood flow visualization and cerebral blood flow MAP > 60 safe Ha 1853 2014 2 RCT N = 8 (105 time point observations) MAP Heart rate Surgical visualization (Wormald)

visualization and cerebral blood flow MAP > 60 safe

TIVA may improve surgical field, but this is based on low quality studies

Kelly 1836 2013 1 Systematic 7 studies qualitatively reviewed No meta-analysis Mixed results with severe limitations instudies Brunner 1838 2018 2 RCT, double-blind IA(n = 33) TIVA(n = 37) 1) Surgical visualization (Wormald) 2)EBL 3) Operative time 4) Time in PACU Higher disease load decreased visualization El-Shmaa 1856 2017 2 RCT, blinded B-blocker MAP Heart rate EBL reviewof RCTs

TABLE XII-2 Evidence for hypotensive anesthesia in sinus surgery Study Year LOE Study Design Study Groups Clinical Endpoint Conclusions Boonmak 1829 2016 1 Systematic reviewof RCTs 1) Visualization (n = 277) a) IA(n = 140) b)TIVA(n = 137) 2) Operative Time (n = 214): a) IA(n = 111) b)TIVA(n = 103) EBL Surgical visualization Operative time Failure of deliberate hypotension Mortality within 24 hours Controlled hypotension with TIVA may improve visualization. DeConde 1835 2013 1 Systematic reviewof RCTs IA(n = 269) TIVA(n = 249) Heart rate

Nitroglycerin Controlled hypotension MAP 60 B-blockers less EBL and higher surgeon satisfaction Ha 1854 2016 2 RCT n = 36 (356 time point observations) MAP Heart rate Both groups IA Surgeon satisfaction scale 1-4

Controlled hypotension

MAP correlated with surgical

Controlled hypotension

MAP correlated with surgical

Middle cerebral artery blood flow

Surgical visualization (Wormald)

Mean arterial pressure Anesthesia time Operative time EBL

Surgical visualization

5) Time to discharge