Comparison of the Time to Orientation between Combining Propofol with Sevoflurane or Sevoflurane in Patients Undergoing Endoscopic Trans-Nasal Surgery: A Randomized Controlled Trial
Background: This study investigates whether combining propofol and sevoflurane for anesthesia maintenance results in faster emergence compared to sevoflurane alone in patients undergoing endoscopic trans-nasal surgery. Methods: Thirty-eight patients were randomized to receive either sevoflurane alone (Group S, n = 19) or propofol plus sevoflurane (Group PS, n = 19) targeting a BIS range of 40 - 60. The primary outcome was time to orientation. Secondary outcomes included time to spontaneous ventilation, eye-opening to sound, extubation, hemodynamics, agitation, coughing, analgesic needs, and PONV. Results: The median time to orientation was significantly longer in Group PS (12 minutes, IQR 6-16) compared to Group S (6 minutes, IQR 5-12) (P < 0.05). Subgroup analysis of cases exceeding 120 minutes of anesthesia showed significantly longer orientation times in Group PS (14.07 ± 6.20 minutes) versus Group S (8.5 ± 3.92 minutes) (P < 0.05). Extubation time was also longer in Group PS (8.63 ± 4.67 minutes) versus Group S (5.95 ± 2.91 minutes) (P < 0.05). Heart rates were higher overall in Group PS (P < 0.05). Conclusion: Using BIS-targeted anesthesia, combining propofol with sevoflurane resulted in a longer time to orientation than sevoflurane alone in patients undergoing endoscopic trans-nasal surgery, particularly when anesthesia exceeded 120 minutes.
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