Propofol Total Intravenous Anaesthesia versus Sevoflurane Inhalational Anaesthesia on Haemodynamic Response Profile during Suspension Laryngoscopy in Adults undergoing Micro laryngeal Surgery.A Randomized Controlled Trial.

Micro-laryngeal surgery (MLS) aided by suspension laryngoscope is a short, microscopic surgical procedure. It results in a robust sympathetic response due to stimulation of the laryngeal tissues resulting in an undue haemodynamic stress: tachycardia, hypertension and arrhythmias. These haemodynamic responses though common and benign, rarely may result in fatal complications in patients with cardio-vascular co-morbidities. Hence, controlling these haemodynamic perturbations becomes of paramount importance. Of the various pharmacologic agents and techniques tried to attenuate the cardiovascular stress response during MLS under suspension laryngoscopy, two commonly used general anaesthetics, sevoflurane (an inhalational agent), and propofol (an intravenous agent) have found favour. Though both attenuate haemodynamic responses, the efficacy of neither is so well established. This randomised study proposes to evaluate propofol total intravenous anaesthesia (TIVA) versus sevoflurane inhalational anaesthesia on haemodynamic control profile in adult patients undergoing MLS using suspension laryngoscope.

All patients undergoing elective MLS will be screened, and those eligible will be enrolled. Enrolled patients will receive either propofol TIVA or sevoflurane inhalational anaesthesia. Demographic and clinical details of the patients will be noted. Haemodynamic changes (pulse rate and systolic blood pressure) during suspension laryngoscopy between them will be compared. Other intraoperative outcomes: frequency of adverse haemodynamic events (hypotension, hypertension, bradycardia, tachycardia), use of rescue drugs for maintaining haemodynamics (mephentermine, tri-nitroglycerine, atropine, metoprolol); and postoperative outcomes: postoperative sedation (assessed using Modified Observer’s Assessment of Alertness/Sedation scale [MOAA/S]) will be compared. We expect to enrol 42-patients in our study.