Open Access Research Article Cattano et al., J Anesthe Clinic Res 2012, 3:3 DOI: 10.4172/2155-6148.1000197 Volume 3 • Issue 3 • 1000197 J Anesthe Clinic Res ISSN:2155-6148 JACR an open access journal Keywords: Propofol; Sevoflurane; TIVA; Platelet function tests; Platelet aggregation Introduction e control of bleeding is important in any surgery, but particu- larly in endoscopic sinus surgery (ESS) where visibility of the field is crucial for the surgeon to perform surgical maneuvers. Hemostasis is important perioperatively in these surgeries and the choice of anesthe- sia can be a deciding factor in reducing patient blood loss. Propofol is a frequent choice of hypnotic anesthetic for TIVA due to its role as a vasodilator [1]. e advantages for ESS of a lower patient blood pressure, however, may be negated by reports that propofol has an adverse effect on blood coagulation [1-6]. e choice of anesthesia regimen is further complicated by research indicating inhalational an- esthetics also inhibit platelet aggregation [5,6]. e purpose of this study was to investigate the potential differ- ences in effects of two anesthesia regimens by measuring blood loss and platelet function. It was our hypothesis that, for the purposes of ESS, TIVA with propofol/remifentanyl would result in reduced blood loss than inhalational anesthesia with sevoflurane/remifentanyl. Methods is study was registered with the National Institutes of Health and can be found at http://clinicaltrials.gov/ct2/show/NCT01214057. Aſter obtaining approval from the Committee for the Protection of Human Subjects, 23 patients aged 18-80, American Society of An- esthesia (ASA) grade I or II, scheduled to undergo endoscopic sinus surgery (ESS) for chronic rhinosinusitis were screened, consented and enrolled. Exclusion criteria included known coagulopathy or use of any drug that could affect thrombocyte function (e.g., aspirin, clopidogrel). Anesthetic Protocol Patients were randomly assigned using a blocked randomization method to receive either propofol/remifentanil (PR, n=12) or sevo- flurane/remifentanil (SR, n=11) general anesthesia. Both patients and surgeons were blinded to the type of anesthetic used. Patients were pre- medicated in the holding area with dexamethasone and midazolam. e patients were monitored by American Society of Anesthesia (ASA) standards with ECG, non-invasive blood pressure, pulse oximetry and temperature probe. eir blood pressure was recorded every 2 minutes for the first 10 minutes, then every 5 minutes. In order to reduce the visual bias of a propofol infusion, anesthe- sia was induced in both SR and PR groups with lidocaine 0.5 mg/kg, propofol infusion at 250 mcg/kg/min and total volume infused was adjusted for an induction dose of 2-3 mg/kg before bolus of muscle relaxant, rocuronium 0.5 mg/kg. Remifentanil infusion was started at a rate of 0.4 mcg/kg/min one to two minutes before the propofol infu- *Corresponding author: Davide Cattano, Associate Professor, Depart- ment of Anesthesiology, University of Texas Medical School at Houston, 6431 Fannin Street, MSB 5.020, USA, Tel: (713) 500-6235; Fax: (713) 500-6208; E-mail: davide.cattano@uth.tmc.edu Received January 26, 2012; Accepted March 13, 2012; Published March 16, 2012 Citation: Cattano D, Gomez-Rivera F, Seitan C, Altamirano AV, Patel CB, et al. (2012) Platelet Function as Affected by Total Intravenous and Inhalational Anes- thesia. J Anesthe Clinic Res 3:197. doi:10.4172/2155-6148.1000197 Copyright: © 2012 Cattano D, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits un- restricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Platelet Function as Affected by Total Intravenous and Inhalational Anesthesia Davide Cattano 1 *, Fernando Gomez-Rivera 2 , Carmen Seitan 1 , Alfonso V. Altamirano 1 , Chirag B. Patel 1 , Amber U. Luong 2 , Martin J. Citardi 2 , Samer Fakhri 2 and Carin A. Hagberg 1 1 Department of Anesthesiology, University of Texas Medical School at Houston, USA 2 Department of Otorhinolaryngology – Head and Neck Surgery, University of Texas Medical School at Houston, USA Abstract Background: Few studies have attempted to demonstrate a benefit of a total intraveneous anesthesia (TIVA) as the sole technique to optimize and reduce bleeding. Also few reports have linked the use of propofol to platelet dysfunction, and while Thromboelastography (TEG ® ) has been used previously, its complement platelet mapping (PM™) has not. The aim of the study was to exclude different causes for blood loss during surgery, including drug effects on platelet function. Methods: After IRB approval, we studied 23 patients scheduled to undergo endoscopic sinus surgery. Using a double-blind experimental method, we randomly assigned patients to receive either TIVA with propofol/remifentanil (PR) or inhalational anesthesia with sevoflurane/remifentanil (SR). Results: Estimated blood loss (PR 152.9 ± 161.3 cc/SR 355.9 ± 393.4 cc) showed no significant group difference. Platelet function was within the normal range for both groups, though several preoperative TEG ® parameters were statistically different between the two groups (PR values were greater than SR values for MA Activator, ADP MA, AA MA and ADP Aggregation; SR value was greater than PR value for ADP Inhibition). Several TEG ® PM™ parameters had statistically significant differences pre- and postoperatively in the SR group (Postoperative were greater for ADP MA and ADP Aggregation; Preoperative value was greater for ADP Inhibition). Individual patient abnormalities were noted. Conclusion: The results do not indicate any significant difference between propofol and sevoflurane as concerns blood loss and platelet inhibition. J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e ar c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research