137 ACTA OTORHINOLARYNGOL ITAL 24, 137-144, 2004 Key words Nasal diseases • Surgical treatment • Endoscopic sinus surgery • Total anaesthesia • Remifentanyl • Propofol Parole chiave Patologia nasale • Trattamento chirurgico • Chirurgia en- doscopica • Anestesia generale • Remifentanil • Propofol Summary Aim of this randomized study (64 patients) was to improve the control of bleeding during functional endoscopic sinusal surgery by means of controlled hypotension achieved through either total intravenous anaesthesia using remifentanyl and propofol (27 patients), or inhaled using isoflurane and fentanyl (37 patients). The following parameters were monitored before administration of anaesthesia (T0), then after 15 (T1), and 30 minutes (T2): systolic, diastolic, and mean arterial pressure; heart rate; concentration of tele-exhaled carbon dioxide (Pet- CO 2 ) and percentage of peripheral saturation of haemoglobin (SPO 2 ); bleeding according to the Fromme-Boezaart scale at T2. Mean arterial pressure values were maintained between 60-70 mmHg throughout surgery. At T0, systolic arterial pres- sure, diastolic arterial pressure and mean arterial pressure val- ues were seen to overlap in the two groups. Both types of anaesthesia were effective in reducing the pressure values of T0-T1 and T1-T2 trends (p<0.0001). Systolic arterial pressure at T1 is lower with total intravenous anaesthesia compared to isoflurane and fentanyl (p=0.02). PetCO 2 and heart rate show a decreasing trend independently of the type of anaesthesia em- ployed. In conclusion, the hypotensive effect of total intra- venous anaesthesia and of isoflurane and fentanyl is equiva- lent, but only total intravenous anaesthesia is effective in re- ducing bleeding during functional endoscopic sinusal surgery. Riassunto L’obiettivo di questo studio randomizzato (64 pazienti) è di ottimizzare il controllo del sanguinamento durante chirurgia funzionale endoscopica naso-sinusale (FESS) mediante la tecnica dell’ipotensione controllata ottenuta con anestesia totalmente endovenosa con remifentanil e propofol (gruppo TIVA 27 pazienti), o inalatoria con isoflu- rano e fentanil (gruppo INA 37 pazienti). Sono stati moni- torati prima dell’induzione anestesiologica (T0), dopo 15 (T1), e 30 minuti (T2) i seguenti parametri: pressione arte- riosa sistolica (PAS), diastolica (PAD) e media (PAM); frequenza cardica (FC); concentrazione di anidride carbonica tele-espiratoria (PetCO 2 ) e percentuale di satu- razione periferica di emoglobina (SPO 2 ); il sanguinamento con la scala di Fromme-Boezaart al tempo T2. I valori di PAM sono stati mantenuti nel range di 60-70 mmHg durante tutta la durata della procedura chirurgica. Al tempo T0 i valori di PAS, PAD e PAM sono sovrapponibili nei due gruppi. Entrambe le tecniche anestesiologiche risultano efficaci nel ridurre i valori pressori del trend T0-T1 e T1- T2 (p<0,0001). La PAS al tempo T1 risulta più bassa con la TIVA rispetto ad INA (p=0,02). PetCO 2 e FC diminuis- cono nel trend considerato indipendentemente dall’anestesia impiegata. Concludendo l’effetto ipotensivo di TIVA e INA è equivalente, ma solamente TIVA risulta efficace nella riduzione del sanguinamento durante FESS. Introduction The aim of functional endoscopic sinusal surgery (FESS) is to restore the drainage and aeration of the paranasal sinuses, while maintaining the natural mu- cociliary clearance mechanism, and seeking to pre- serve the normal anatomical structures 1 2 . The excel- lent results achieved have led to FESS becoming a widely used endoscopic surgical technique. Howev- er, this surgery can lead to serious complications such as orbit cellulitis, rhino-liquoral fistulas, lesions to the optic nerve of the dura mater, meningitis 2-4 . These complications are often the result of excessive bleeding which may occur during surgery 5 . Hence, to improve the surgical technique by reducing the in- cidence of complications, it is important to have a surgical field as free of blood as possible to improve visibility. This can be achieved with the use of local anaesthesia, with topically applied vasoconstrictors or general anaesthesia, associated with controlled hy- potension. Total intravenous general anaesthesia (TI- VA), with remifentanyl and propofol (REM/PRO), should be the most effective technique to obtain re- duced bleeding. Remifentanyl, as all morphine-like molecules, acts on specific receptors located in the neuraxis producing a state of analgesia, sedation and Total intravenous anaesthesia in endoscopic sinus-nasal surgery Anestesia generale endovenosa nella chirurgia endoscopica naso-sinusale G. TIRELLI, S. BIGARINI, M. RUSSOLO, U. LUCANGELO 1 , A. GULLO 1 Department of Otorhinolaryngology, Head and Neck Surgery, Cattinara Hospital, University of Trieste; 1 Department of Anaesthesia and Intensive Care, Cattinara Hospital, University of Trieste, Italy