TIVA for FESS Surgical Field — FRCA Final MCQ

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ModerateGeneral AnaesthesiaTIVA for FESS Surgical FieldFRCA Final

A 40-year-old man (ASA I) is scheduled for functional endoscopic sinus surgery (FESS). The surgeon requests total intravenous anaesthesia (TIVA) rather than volatile anaesthesia. What is the primary reason TIVA may be preferred for FESS?

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Correct answer: B — TIVA eliminates the need for neuromuscular monitoring

TIVA with propofol/remifentanil is preferred for FESS because it produces less surgical field bleeding compared to volatile-based anaesthesia. Propofol causes less vasodilation than volatile agents, and remifentanil provides titratable controlled hypotension, both contributing to a drier surgical field. This improves endoscopic visualisation and surgical precision, reducing complications. The Boezaart grading scale is used to assess surgical field quality. Reduced PONV is a secondary benefit. TIVA does not eliminate the need for neuromuscular monitoring.

Reference: RCOA – 2023 – ENT anaesthesia module; Wormald PJ – 2005 – Surgical field bleeding in FESS