Effects of different anesthesia methods on bleeding and prognosis in endoscopic sinus surgery: a meta-analysis and systematic review of randomized controlled trials

The aim of this paper was to assess whether intravenous anesthesia and inhalation anesthesia will affect intraoperative bleeding and prognosis in patients with endoscopic sinus surgery. The Cochrane Library, PubMed, Embase, and the Web of Science were systematically searched to identify relevant randomized controlled trials investigating the impact of various anesthesia methods on patients undergoing endoscopic sinus surgery from January 1, 1990, to July 1, 2024. The primary outcome measures comprised intraoperative blood loss and scoring systems evaluating bleeding in the surgical field. Secondary outcome measures included common postoperative complications such as nausea, vomiting, and pain, among others. Data synthesis was conducted using risk ratios or standardized mean differences, along with 95% confidence intervals. The original study protocol was prospectively registered with PROSPERO (CRD42022359773). A total of 26 randomized controlled trials involving 1472 patients were included in this meta-analysis. Lower blood loss is found during intravenous anesthesia compared to inhalation anesthesia (SMD, 0.69; 95% CI, 0.21 to 1.18; P=0.005; I2=90%). The results of several scoring systems for assessing surgical field bleeding have shown the superiority of intravenous anesthesia. In addition, the duration of operation under intravenous anesthesia is shorter (SMD=0.15; 95% CI: 0.03 to 0.26; P=0.01; I2=46%). However, the risk of postoperative nausea and vomiting in the inhalation anesthesia group was lower than that in the intravenous anesthesia group (RR=0.72; 95% CI: 0.55 to 0.93; P=0.01; I2=0). Univariate meta-regression analysis indicated that age may be one source of heterogeneity. Intraoperative blood loss and operation time are more advantageous in intravenous anesthesia. Anesthesiologists and surgeons should make individualized decisions based on the patient's condition and formulate a comprehensive plan during the perioperative period to bring greater benefits to the patient.