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Background: 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.
Objectives: 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).
Patients and Methods: 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; propofolremifentanil
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.
Results: 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).
Conclusions: 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.

     

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