The current practice of lowering mean arterial pressure (MAP) during endoscopic sinus surgery (ESS) is common, but unproven with regard to peer reviewed literature. The controlled hypotension induced is aimed for improved surgical field and lower the blood loss. Lower mean arterial pressures especially for prolonged surgeries may result in end organ hypo perfusion.
The authors reviewed all patients who underwent outpatient endoscopic sinus surgery for the diagnosis of chronic sinusitis from January 1, 2012 to December 31, 2012 at Memorial Hermann Hospital – Texas Medical Centre. We individually reviewed case sheets of every patient and documented blood loss as recorded on the anaesthesia record or in the surgical procedure note, among other variables. A total of 326 patients were included in this study. The median estimated blood loss (EBL) was found to be 50 ml. The multivariate regression analysis between these three groups showed that EBL was higher in MAP 75 group. The average of EBL in MAP75 group and the average of EBL in MAP 65-70 group is 42% higher than that in MAP>75 group when other variables were fixed. Hence we found the trend toward higher blood loss with lower MAP. The authors conclude that lower MAP does not result in lower EBL in endoscopic sinus surgery. Furthermore, increases in BMI and crystalloid administered during an anesthetic management of these cases correlates with increased estimate blood loss.
Bleeding in Fess, mean arterial pressure