Septoplasty Anaesthesia: Optimising Haemodynamics, Blood Conservation, and Postoperative Nausea Control: A Randomised Comparative Study

Abstract

Septoplasty is a common otolaryngological procedure in which a bloodless surgical field is critical for safe and accurate surgery. Deliberate hypotension is widely used to minimise intra-operative bleeding and optimise visibility, but the relative haemodynamic stability, blood-conservation efficacy, and postoperative nausea and vomiting (PONV) profile of total intravenous anaesthesia (TIVA) compared with combined intravenous–inhalational techniques in septoplasty are not fully established. This study aimed to compare propofol–remifentanil TIVA with a combined intravenous–inhalational technique (isoflurane plus metoprolol and glyceryl trinitrate) in patients undergoing septoplasty, with regard to haemodynamic stability, intra-operative blood loss, and PONV. A prospective, single-centre, parallel-arm, open-label randomised clinical trial was conducted at Al-Najaf Teaching Hospital, Iraq, between December 2022 and October 2023, and is reported in accordance with the CONSORT 2010 statement. Forty patients aged 16–50 years (ASA physical status I–II) were randomly allocated 1:1 by an independent biostatistician using a computer- generated block-randomisation sequence (block size 4). Allocation was concealed in sequentially numbered, opaque, sealed envelopes, which were opened only after enrolment and immediately before induction. Patients were assigned to combined intravenous–inhalational anaesthesia (Group A, n=20) or TIVA with propofol and remifentanil (Group B, n=20). The pre-specified primary endpoint was the proportion of patients achieving and maintaining the deliberate-hypotension target (MAP 50-65 mmHg) for ≥90% of the intra-operative period. Secondary endpoints were intra-operative blood loss, PONV incidence within 24 h, operative time, and recovery profile. Heart rate, systolic and diastolic blood pressure, MAP, intra-operative blood loss, and PONV up to 24 h after surgery were recorded. Both groups achieved the deliberate- hypotension target within five minutes of induction and maintained stable haemodynamics throughout surgery. Intra-operative blood loss did not differ significantly between groups (TIVA 119.0±14.10 mL vs combined 121.5±14.60 mL; P=0.548). PONV occurred in 25% of TIVA patients and 35% of combined- anaesthesia patients (P=0.503); no episodes of vomiting were recorded in either group within 24 h. Female sex was significantly associated with PONV (P=0.014). Operative time and recovery profiles were similar between the two groups. Both TIVA and combined intravenous–inhalational anaesthesia, when titrated to identical haemodynamic targets, showed no statistically significant differences in haemodynamic stability, intra-operative blood loss, or PONV outcomes during septoplasty. Because the study was not designed or powered as a formal equivalence or non-inferiority trial, these findings should be interpreted as hypothesis- generating rather than as proof of clinical equivalence. Either technique may be selected on the basis of patient-specific factors, drug availability, and clinician preference.