Background
The aim of this retrospective study is to assess the safety of Total IntraVenous Anesthesia (TIVA) for patients  with cystic fybrosis (CF) or Kartagener syndrome (KS) that underwent Functional endoscopic sinus surgery (FESS) procedures in the years between 2014 - 2017.  
TIVA has been pointed as the first choice for the restraint of bleeding compared to inhaled agents in this kind of procedures. In this particular cluster of patients, the choice of anesthesia is even more critical due to higher risks of respiratory depression or postoperative pulmonary function decline.  There is scant literature about this matter, but TIVA seems to ensure the most rapid awakening and tracheal extubation  times with the lowest risk of respiratory depression.

Methods
We reviewed anesthesia charts and hospitalization records of 31 patients (17 females, 14 males; age  4 to 25 yrs), that underwent FESS (18) or FESS revision (13) between 2014-2017;  29 were affected by CF and 2 by KS. 
Written consent for surgical and anesthetic procedures was obtained for all patients. A preoperative spirometry was performed.
All the procedures were conducted with TIVA (Propofol and Remifentanil) Younger children were induced with inhaled agents (N2O, Sevoflurane) and maintained with TIVA. Oral intubation was performed in all cases. We evaluated the time between end of the procedure and oral extubation, the occurrence of perioperative or post-operative complications, time of discharge from hospital.

Results
All 31 patients have been discharged 24 hours after the surgery. Propofol administration was stopped immediately before the placement of nasal swabs, remifentanil was gradually reduced and completely stopped at the removal of sterile field. All patients resumed consciousness in times between 3 to 8 minutes after remifentanil suspension and were extubated 1 to 4 minutes after. Perioperative complications occured in 5 cases: 3 hypotension events after induction that required administration of ephedrine, 2 mild desaturations (Spo2 92%) that required deepening anesthesia and spontaneously resolved.  

Conclusions
These data suggest that TIVA is a safe anesthesia technique for patients with CF or KS in this particular surgical field. Anesthesia for CF patients should be object of further studies.

02 / TIVA safety in pediatric patients with cystic fybrosis and Kartagener syndrome undergoing FESS.