Total Intravenous Anesthesia Versus Inhaled Sevoflurane in Obstructive Sleep Apnea Surgery: A Randomized Controlled Trial. (14th October 2022)

• Record Type: Journal Article
• Authors: Estephan, Leonard E.; Sussman, Sarah; Stewart, Matthew; Zhan, Tingting; Thaler, Adam; Boon, Maurits; Hunt, Patrick; Huntley, Colin
• Is Part Of: Laryngoscope. Volume 133:Number 4(2023)
• Page Start: 984
• Page End: 992
• Publication Date: 2022-10-14
• Subjects: inhalational anesthesia -- hypoglossal nerve stimulation -- obstructive sleep apnea -- recovery time -- total intravenous anesthesia; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.30438
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objective: 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. Study Design: Randomized controlled trial. Methods: 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. Results: 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). Conclusion: 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. Level of Evidence: 3 Laryngoscope, 133:984–992, 2023 Abstract : This randomized controlled trial suggests that OSA patients undergoing upper airway surgery with total intravenous anesthesia as compared to inhalational anesthesia experience reductions in recovery time. Additional recovery advantages include lessened oxygen supplementation requirements and a more rapid return to alertness. Future work toward developing optimized anesthetic guidelines for OSA patients is merited.