Application effect and safety of intravenous inhalation of propofol and nitrous oxide combined anesthesia in elderly patients undergoing endoscopic sinus surgery

Li Qiong; Yang Wenjing; Wang Guyan

doi:10.3760/j.issn.1673-4777.2025.07.020

Abstract：Objective To investigate the effect and safety of intravenous inhalation of propofol combined with nitrous oxide combined anesthesia in elderly patients undergoing endoscopic sinus surgery.Methods Sixty elderly patients undergoing endoscopic sinus surgery under general anesthesia in Beijing Tongren Hospital,Capital Medical University from February 2022 to September 2023 were selected.According to the random number table method,they were divided into total intravenous anesthesia(TIVA)group and nitrous oxide group,with 30 cases in each group.Both groups received intravenous induction of general anesthesia with laryngeal mask airway.Anesthesia was maintained with propofol and remifentanil during operation in group TIVA;anesthesia was maintained by inhalation of propofol and remifentanil combined with nitrous oxide in the nitrous oxide group,and all patients recovered naturally after operation.The postoperative recovery time,post-anesthesia care unit(PACU)stay time and the lowest oxygen saturation value were recorded.Intraoperative hemodynamic changes and vasoactive drug usage were recorded.The Boezaart scale(BS)score of intraoperative blood loss,intraoperative blood loss volume and bleeding rate were recorded.The incidence of postoperative adverse reactions was recorded.Results The emergence time and PACU stay time in the nitrous oxide group were shorter than those in the TIVA group[10.0(8.0,11.0)min vs 15.0(14.0,17.0)min,(28.2±2.7)min vs(35.3±2.4)min],the lowest oxygen saturation in the recovery room was higher in the TIVA group[96.0％(95.0％,97.0％)vs 92.5％(92.0％,95.0％)],and the intraoperative use of ephedrine was lower than that in the TIVA group[3.3％(1/30)vs 23.3％(7/30)](all P＜0.05).There were no significant differences in hemodynamic parameters,BS score,total bleeding volume and bleeding velocity between the two groups at different time points(all P＞0.05).There were no adverse reactions such as dizziness,headache,nausea and vomiting in the two groups on the day of operation and the second day after operation.Conclusions The application of propofol combined with nitrous oxide intravenous inhalation combined anesthesia in elderly patients with endoscopic sinus surgery can achieve similar surgical conditions as TIVA,and can provide more stable hemodynamics,and faster recovery time without increasing adverse reactions.