{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:42:23Z","timestamp":1785436943678,"version":"3.56.0"},"reference-count":48,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T00:00:00Z","timestamp":1779408000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009043","name":"University of Patras","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009043","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/017wvtq80","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Controlled hypotension during functional endoscopic sinus surgery (FESS) improves surgical field visibility but may pose a risk of subclinical cerebral hypoperfusion. Serum S100\u0392 and neuron-specific enolase (NSE) are established biomarkers of glial and neuronal injury and may reflect perioperative neuroprotection associated with different anesthetic regimens. This study evaluated the effect of four anesthetic protocols on perioperative brain biomarker release during FESS. Materials and Methods: In this single-center, randomized, controlled trial, 88 adult patients (ASA I\u2013III) undergoing FESS under moderately controlled hypotension (mean arterial pressure &lt; 55 mmHg) were allocated to one of four groups: propofol\u2013remifentanil, propofol\u2013remifentanil with ketamine\u2013magnesium, sevoflurane\u2013remifentanil, or sevoflurane\u2013remifentanil with ketamine\u2013magnesium. Serum S100\u0392 and NSE concentrations were measured at three timepoints: early intraoperatively, during hypotension, and at the end of surgery. Biomarker data were analyzed using nested ANOVA and linear mixed-effects models adjusted for relevant covariates. Secondary outcomes included recovery characteristics, surgical field quality, bleeding scores, and perioperative hemodynamics. Results: Baseline demographic and perioperative characteristics were comparable across groups. The group receiving sevoflurane\u2013remifentanil combined with ketamine\u2013magnesium showed the lowest S100B levels (p = 0.01 compared to the propofol\u2013remifentanil group; p = 0.04 compared to the sevoflurane\u2013remifentanil group). Additionally, NSE concentrations were markedly lower in both sevoflurane groups (sevoflurane\u2013remifentanil and sevoflurane\u2013remifentanil plus ketamine\u2013magnesium) compared to the propofol\u2013remifentanil group (p = 0.003 and p = 0.007, respectively). No intergroup differences were observed at baseline and surgical field quality, bleeding, and hemodynamic parameters did not differ significantly among groups. Recovery and extubation times were shortest with propofol\u2013remifentanil, whereas ketamine\u2013magnesium prolonged emergence. Conclusions: Anesthetic technique significantly influences perioperative brain biomarker release during FESS. Sevoflurane-based regimens, with or without ketamine\u2013magnesium, demonstrate more favorable neurobiological profiles under controlled hypotension, although propofol-based anesthesia offers faster recovery.<\/jats:p>","DOI":"10.3390\/medicina62061006","type":"journal-article","created":{"date-parts":[[2026,5,22]],"date-time":"2026-05-22T09:17:09Z","timestamp":1779441429000},"page":"1006","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variations in S-100\u0392 and Neuron-Specific Enolase Levels During Functional Endoscopic Sinus Surgery Under Moderately Controlled Hypotension Using Four Distinct Anesthetic Protocols: A Randomized Controlled Study"],"prefix":"10.3390","volume":"62","author":[{"given":"Sotiria","family":"Rizopoulou","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0642-6697","authenticated-orcid":false,"given":"Spyridon","family":"Lygeros","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3152-4777","authenticated-orcid":false,"given":"Anne-Lise","family":"de Lastic","sequence":"additional","affiliation":[{"name":"Laboratory of Immunohematology, Pathology Clinic, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Georgakopoulou","sequence":"additional","affiliation":[{"name":"Laboratory of Immunohematology, Pathology Clinic, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Daniilidis","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasia","family":"Voulgary","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4900-2456","authenticated-orcid":false,"given":"Diamanto","family":"Aretha","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care Medicine, General University Hospital of Patras, School of Medicine, University of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1002\/wjo2.222","article-title":"Trends and complications in functional endoscopic sinus surgery and balloon sinuplasty: A TriNetX database analysis","volume":"11","author":"Bitner","year":"2025","journal-title":"World J. 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