Effect of Anesthetic Agents on Middle Ear Pressure: Systematic Review and Meta-Analysis.

Abstract

Objective: To assess and compare the effects of these agents on middle ear pressure (MEP). Anesthetic agents can significantly alter MEP, which is a critical factor in middle ear surgeries that require stability to prevent complications. Different anesthetics, including inhalational and intravenous agents, have varying effects on MEP.

Methods: A systematic search was conducted across PubMed, Embase, the Cochrane Library, and Scopus, following preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. Studies that evaluated MEP changes before and after anesthesia using tympanometry were included. Relevant data, such as anesthetic type, patient demographics, MEP measurements, and reported complications, were extracted. A meta-analysis using a random-effects model was conducted to account for variability across studies.

Results: Twelve studies, including 980 patients aged 2-76 years, were analyzed. Desflurane caused the most significant increase in the MEP. Isoflurane showed minimal changes in MEP, making it a safer option for middle-ear surgery. Total intravenous anesthesia (TIVA) with propofol maintained stable MEP, highlighting its suitability for these procedures. Nitrous oxide decreased MEP postoperatively but posed risks during the early phases of administration, especially in patients with eustachian tube dysfunctions. Dexmedetomidine significantly elevated MEP, while halothane, alone or combined with nitrous oxide, had negligible effects on MEP.

Conclusion: The findings of this study reveal that isoflurane and TIVA with propofol are suitable anesthetic options for middle ear surgery due to their minimal impact on MEPs. In contrast, desflurane and sevoflurane should be used cautiously because they can significantly elevate MEP.