4 Anaesthesia and patient blood management

4.1 Volatile or total intravenous general anaesthesia?

Propofol-based TIVA has been associated with reduced blood loss in several settings, possibly due to the effects propofol has on haemodynamics and uterine tone.271–273 Propofol, commonly combined with remifentanil, has been shown to result in less blood loss during endoscopic sinus surgery (median blood loss 19 mL vs 128 mL; p=0.004) and during tonsillectomy (1.2 mL/kg less; p=0.013)274 when compared with volatile anaesthesia. Likewise, for first trimester pregnancy termination, propofol anaesthesia reduced blood loss (18.8 mL vs 40.4 mL; p=0.0011).273 However, given the absolute reductions in blood loss found, the clinical impact of TIVA with regard to blood conservation must be minimal in these groups of patients.

Of potential benefit was reduction in blood loss observed during spinal surgery performed under propofol-based TIVA compared with sevoflurane (106 mL vs 315 mL; p=0.004), for the same blood pressure target.272