Raikundalia MD, Cheng TZ, Truong T, et al. E-mail address: [emailprotected] (A. Saxena). This is referred to as an asleep-staged extubation and involves withdrawal of the tracheal tube until the tip rests above vocal cords in the supralaryngeal space. General anesthesia means youre unconscious and dont feel any pain. Fever higher than 101 degrees Fahrenheit in the days following surgery, Constant clear watery discharge from the nose a week after surgery, Steady, brisk, nose bleeding that doesnt get better after using decongestant spray. Range of S-100 levels during, 78. Maintaining superior hemodynamic stability during FESS is required intraoperatively, and special attention should be directed to patients with preexisting coronary artery disease and systemic hypertension (HTN). Healthcare providers perform this surgery to treat chronic sinusitis and to remove nasal polyps. It can be used to assist with breathing during surgery or to support breathing in people with lung disease, chest trauma, or airway obstruction. Upon review, 260 references were identified as pertinent and 164 articles were selected for this publication. Major complications of airway management in the UK. The doctor uses a device called an endoscope, along with other tools, to access and treat the problem area through the nostrils. The insertion procedure is brief lasting only a few minutes. Propofol versus sevoflurane: bleeding in, 80. Anesthesiology 2009;110:8917. J Am Coll Cardiol 2014;64:e77137. Higashizawa T, Koga Y. Endoscopic sinus surgery is usually performed as an outpatient procedure with the patient under general anesthesia (asleep). Le Guen M, Paternot A, Declerck A, et al. Endoscopic sinus surgery is a procedure to remove blockages and treat other problems in the sinuses using an endoscope a thin, rigid tube with a camera and a light. A retrospective study by Gengler et al10 of over 900 patients after sinonasal surgery demonstrated that the patients age (older than 50), duration of surgery (longer than 80min), and the requirement for nasal packing carried a statistically higher risk for unanticipated hospital admission. 23. Appendix 5. Svider PF, Nguyen B, Yuhan B, et al. The perioperative use of an oral (eg, metoprolol) and IV -blockers (eg, esmolol, labetalol) desirably elicits negative chronotropic and inotropic effects, resulting in improved operating conditions89,116121. FESS is characterized by low postoperative pain scores146, and remifentanil represents a nearly ideal intraoperative opioid due to its context-insensitive half-life, superior potency and titratability, and demonstrated improvement of respiratory and general patient recovery after outpatient surgery (Nekhendzy and colleagues)4. [5] [6] Furthermore, NT intubation is better tolerated than endotracheal intubation in the awake patient and should therefore be considered when there is a need for awake intubation. COVID-19 Updates . 123. You may have other follow-up visits, depending on your situation. The debilitating symptoms of CRS and frequent revision surgeries may leave a long-standing negative psychological impact, and result in chronic depression and/or pain in up to 20% of patients6,7. They insert surgical tools alongside the endoscope to use the endoscope to remove bone, diseased tissue or polyps that may be blocking your sinuses. Minor bleeding, pain, congestion, discharge and fatigue are common after the surgery, but should go away in one to three weeks. Pavlin JD, Colley PS, Weymuller EA Jr, et al. 130. 1 Any surgery that requires intubation , which is when a tube is placed in the mouth and down the airway can also lead to mouth and throat discomfort. The possibility of difficult mask ventilation and difficult tracheal intubation shall always be considered in OSA patients 33-35. 59. If your surgery involves general anesthesia, dont eat or drink anything after midnight the day of your surgery. The adult patients presenting for FESS are diverse and could be either completely healthy (American Society of Anesthesiologists [ASA] physical status I) or have controlled systemic diseases of varying severity (ASA physical status IIIII). Chang CH, Lee JW, Choi JR, et al. 14. Abdelmalak B, Makary L, Hoban J, et al. The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after, 151. These surgeries can be performed with local anesthesia and sedation or general anesthesia with an LMA or endotracheal tube. Main literature search (the numbers represent the specific, (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (endoscopy [mesh] OR endoscop* [tw]) AND (postoperat* [tw] OR Postoperative Complications [mesh] OR postoperative period[mesh] OR complication* [ti]) AND English [lang]. Ankichetty SP, Ponniah M, Cherian V, et al. Blood loss during, 91. The influence of positive end-expiratory pressure on surgical field conditions during. Incidence and predictors of difficult and impossible mask ventilation. Functional endoscopic sinus surgery (FESS) is standard surgery for chronic sinus problems that keep you from breathing with ease. Eberhart LH, Folz BJ, Wulf H, et al. 127. NOSE AND THROAT SURGERIES SUCH AS TONSILLECTOMY AND RHINOPLASTY: Almost all nose and throat surgeries require an airway tube, so anesthetic gases and oxygen can be ventilated in and out through your windpipe safely during the time the surgeon is working on these breathing passages. Created for people with ongoing healthcare needs but benefits everyone. Ther Clin Risk Manag 2010;6:11121. Your healthcare provider will do a pre-operation screening to be sure youre able to have the surgery. 126. Complications of using, 54. FESS is the standard procedure to treat serious sinus conditions. You wont be able to drive after surgery, so youll need someone to take you home and stay with you that first night. When you sneeze, you may blow out bloody discharge or mucus. A few strategies can be tried. Dexmedetomidine improves the quality of the operative field for. Comparison of the reinforced. 62. They may also prescribe antibiotics to help prevent infection. 17. Laryngoscope 2010;120:6358. Elsersy HE, Metyas MC, Elfeky HA, et al. The use of FLMA in lieu of ETT will enable smooth patient awakening and allow for safe reduction of the level of anesthesia near the end of the surgery4,58. 110. 36. Grzegorzek T, Kolebacz B, Stryjewska-Makuch G, et al. Curr Opin Crit Care 2001;7:2216. Tests they may use include: Your healthcare provider will let you know what to do before your surgery. Other NG tube complications include: 4 Abdominal cramps Aspiration Diarrhea Injury to the esophagus, throat, sinuses, or stomach Swelling Diarrhea This may be related to the complexity of nasal vascular structure and to the predominantly capillary nature of the bleeding80,89. It is used to: 2 Protect the airway if there is a threat of an obstruction Give anesthesia for surgeries involving the mouth, head, or neck (including dental surgery) What to Expect When Intubated Intubation is a common procedure. Kim H, Choi SH, Choi YS, et al. Thiruvenkatarajan V, Watts R, Calvert M, et al. A recent meta-analysis by Kim et al69 has shown that intraoperative administration of tranexamic acid IV 1015mg/kg (not to exceed 1g total dose), decreases intraoperative bleeding, operative time and improves surgical visibility without side effects. 102. Ellsworth WA, Basu CB, Iverson RE. Although current evidence supports the postdischarge use of NSAIDs and gabapentin for the control of pain after FESS161,162, the prescription of postoperative opioids after FESS continues to predominate among the members of the surgical community146,163. The nonsteroidal anti-inflammatory medications (NSAIDs) and herbal supplements such as the 4 Gs (garlic, ginkgo biloba, ginseng, ginger) and certain vitamins (eg, vitamin E), may provoke microvascular bleeding and should ideally be discontinued at least 1 week before surgery when possible17,18. You can help prevent recurring sinus problems by following your post-surgery care and giving your nose time to heal. Disastrous anesthesia-related complications . Anesth Analg 2011;112:26781. Intubation is a standard procedure that involves passing a tube into a person's airway. the use of FLMA may offer significant advantages, including decreased incidence of the upper airway trauma and adverse respiratory events, facilitation of maintenance of anesthesia and quality of surgical field, and smoother and faster emergence from anesthesia4,4754. Cook T, Woodall N, Frerk C. 4th National Audit Project of the Royal College of Anaesthetists. Campbell AP, Phillips KM, Hoehle LP, et al. Doctors often perform it before surgery or in emergencies to give medicine or help a person breathe. Surgical conditions during FESS; comparison of dexmedetomidine and, 116. Acta Otorhinolaryngol Ital 2004;24:13744. [Epub ahead of print]. Any surgery has potential complications, but sinus surgery complications are rare. Talk to a healthcare provider if youre weighing the risk and benefits of sinus surgery. The use of propofol for its antiemetic effect: a survey of clinical practice in the United States. Before you leave, your provider will give you information about taking care of yourself as you recover. Pilot study comparing, 94. A main and additional specific literature searches using MeSH terms, title words, and text words were performed in PubMed for the years January 1, 2000 to October 27, 2019 (Appendix 1). 60. There are, however, a couple of potential risks associated: 1 Acute bacterial sinusitis, infection of the sinuses by bacteria Excessive bleeding in the affected area Your healthcare provider will tell you about potential complications, but a few you may experience include: It can take a few months before you feel as if youre back to normal. If you have chronic sinusitis and medical treatment hasnt helped, ask your healthcare provider if FESS is an option. Prevention of this complication begins with recognition of a potentially difficult intubation and applying good practice rules. The use of the centrally acting 2-adrenoreceptor agonists, such as clonidine or dexmedetomidine, produces a dose-dependent reduction of the central sympathetic outflow, with resultant decrease in blood pressure and HR. Bettelli G. High risk patients in day surgery. Some conditions that may require temporary tube feeding through a nasogastric tube include: Difficulty swallowing ; Head and neck cancers. Albu S, Gocea A, Mitre I. Preoperative treatment with topical corticoids and bleeding during primary, 25. Nasotracheal intubation is when the tube is put in through the nose. Kheterpal S, Healy D, Aziz MF, et al. You have a fever. Preoperative corticosteroid oral therapy and intraoperative bleeding during, 26. For the most part, FESS has relatively few complications. Medicine (Baltimore) 2019;98:e17254. Poorly controlled HTN carries increased risk of microvascular bleeding or postoperative hematoma formation12. Routine ASA monitoring is usually sufficient, even if CH is used intraoperatively. Under moderate CH, synergistic interactions of IV propofol and remifentanil optimize surgical field through a combination of cardiac negative chronotropic and inotropic effects70,71,73,7885. All rights reserved. Tyler MA, Lam K, Ashoori F, et al. Compared with MAC, general anesthesia provides adequate amnesia, protects patients airway, assures adequate gas exchange, and abolishes patients movement4. 19. Every persons situation is different, but most healthcare providers recommend the following: Healthcare providers do functional endoscopic sinus surgery and balloon sinuplasty by inserting surgical tools into your nose. Many nasal procedures can successfully be performed under local anesthesia with sedation. Application of deliberate hypotension for orthognathic surgeries decreases blood loss. 3. Desflurane versus sevoflurane for maintenance of outpatient, 67. But you can stay intubated (with a breathing tube in place) for days or weeks depending on your medical needs. Am J Rhinol Allergy 2018;32:36973. Tirelli G, Bigarini S, Russolo M, et al. Oral bisoprolol improves surgical field during, 118. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Your healthcare provider puts decongestant medication in your nose. Smith I, Van Hemelrijck J, White PF. The forehead sensors for electroencephalogram-based assessment of the depth of anesthesia usually do not interfere with intraoperative use of stereotactic navigation system by the surgeon and can be particularly beneficial when TIVA is used. Saxena, Amit MD; Nekhendzy, Vladimir MD, FASA, Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA. Dexmedetomidine has been extensively studied due to its dose-dependent sedation and anxiolysis, potentiation of the opioid analgesia, absent or minimal respiratory depression, and additional antisialagogue, antitussive and sympatholytic properties102110. You may. Tewfik MA, Frenkiel S, Gasparrini R, et al. After surgery, you will spend a few hours in a recovery room to allow you to wake . 29. Cassano M, Longo M, Fiocca-Matthews E, et al. 45. Nekhendzy V, Lemmens HJ, Vaughan WC, et al. Jaw surgery may be a corrective option if you have jaw problems that can't be resolved with orthodontics alone . Martin-Castro C, Montero A. 128. Am J Ther 2010;17:58695. The effect of oral clonidine premedication on blood loss and the quality of the surgical field during, 97. Preparation. Nekhendzy V, Ramaiah VK. (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw]) AND English [lang] AND (Preoperative Care[mesh] OR preoperative assessment [tw] OR preoperat* [ti] OR (anesth* [ti] AND (evaluat* [ti] AND assess* [ti]))), (Nerve Block [mesh] OR nerve block [tw] OR , ((Anesthetics, Inhalation [mesh] AND Anesthetics, Intravenous [mesh]) OR (inhal* [ti] AND intravenous [ti]) OR (TIVA [ti] AND inhal* [ti])) AND ((paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw])) AND English [lang], (hypotension [ti] OR blood Pressure [mesh] OR , (Pain Management [mesh] OR pain measurement [mesh] OR Pain, Postoperative [mesh] OR pain [mesh] OR pain [ti]) AND (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw]) AND English [lang], (inpatient [ti] OR outpatient [ti] OR inpatients [mesh] OR outpatients [mesh] OR patient admission [mesh] OR admission [ti] OR admitted [ti]) AND ((paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw])) AND English [lang], Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0/, www.anesthesiologynews.com/download/3Maneuvers_ANGAM10_WM.pdf, Anesthetic considerations for functional endoscopic sinus surgery: a narrative review, Articles in Google Scholar by Amit Saxena, MD, Other articles in this journal by Amit Saxena, MD, Privacy Policy (Updated December 15, 2022). J Otolaryngol 2006;35:23541. Nevertheless, many of the patients with nasal polypoid disease will have received a preoperative course of oral steroid therapy in an attempt to reduce intraoperative bleeding and improve surgical visibility2328. Malnutrition. Some small randomized trials have shown that compared with IV remifentanil or esmolol, IV dexmedetomidine produced comparable decreases in HR and MAP113,114, but similar to clonidine caused more somnolence and prolonged recovery room stay in the immediate postoperative period115. Comparison between dexmedetomidine and, 114. Functional endoscopic sinus surgery (FESS) is a minimally invasive technique used to clear blockages in the sinuses and make breathing easier. Cardesin A, Pontes C, Rosell R, et al. 44. Prevention of perioperative and. Ronthal M, Rontal E, Anon JB. J Clin Anesth 2010;22:3540. Endoscopic sinus surgery is one of the most commonly performed surgical procedures in the United States1,2. A deviated septum can make it harder to breathe through your nose and can increase the risk of sinus infections due to poor drainage. Fedok FG, Ferraro RE, Kingsley CP, et al. Wolters Kluwer Health They connect with your nasal cavity. Hall JE, Uhrich TD, Barney JA, et al. You should see your healthcare provider for follow-up visits a few weeks after your surgery so they can clean your nose and check on your progress. Sethi RKV, Miller AL, Bartholomew RA, et al. Comparison of sodium nitroprusside- and esmolol-induced hypotension for, 79. Evaluation of the patients cardiac status should follow the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines on perioperative evaluation and care for noncardiac surgery13. Eur J Anaesth 2008;25:2616. Kim H, Ha SH, Kim CH, et al. Heres information about this process: Healthcare providers typically do this surgery when other procedures havent solved your sinus issues. The anesthesiologist should act as a knowledgeable consultant for appropriate patient selection and preparation, understand some of the unique anesthetic goals for FESS (Table 1) and be comfortable with total intravenous anesthesia (TIVA).3,4 Most of the FESS procedures are performed in a free-standing ambulatory surgical centers, which presents additional challenges due to a combination of limited anesthesia back-up, variability of monitoring modalities and anesthesia equipment, and the pressure to produce cost-effective, efficient, and quality care. Besides medications, the influence of intraoperative factors, such as carbon dioxide (CO2) level and mechanical ventilation modalities on intraoperative bleeding and quality of surgical field has been investigated in a number of ESS trials94,132,133. Taheri A, Hajimohamadi F, Soltanghoraee H, et al. Comprehensive Review on Endonasal Endoscopic Sinus Surgery. Major perioperative considerations should center around general anesthetic requirements for head and neck surgery3, and those specific for FESS (Table 1). Nasal saline mist can be used every three to four hours after surgery to keep your nose moist and humidified. The authors identify and elaborate in detail on essential intraoperative considerations, such as the use of controlled hypotension and total intravenous anesthesia, discuss their advantages and disadvantages and provide practical recommendations for management. Please try after some time. Sajedi P, Rahimian A, Khalili G. Comparative evaluation between two methods of induced hypotension with infusion of, 132. 143. Intubation is a common, lifesaving medical procedure. Soppitt AJ, Glass PS, Howell S, et al. Heres an overview of the process: Everyones situation is different, but most functional endoscopic surgeries last about two hours. 86. Your healthcare provider will administer general anesthesia just before your surgery begins. Cattano D, Rane M. Ventilation through an extraglottic tracheal tube: a technique for deep extubation and airway control. The most suitable candidates for this procedure have recurrent acute or . 161. Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. 147. Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. Anesth Analg 2003;97:16338. Please enable scripts and reload this page. Complication rates after. Comparison of the optimal effect-site concentrations of, 137. In the pre-operative setting, NT intubation should be considered in patients requiring maxillofacial surgery or dental procedures. 149. 48. Ghodraty MR, Hasani V, Bagheri-Aghdam A, et al. Page 2 of 4 . Acta Otorrinolaringol Esp 2013;64:1339. The aim of our review is to look at the increasing body of literature highlighting the various . Nasogastric Tube Complications. 7. Most patients do not require nasal packing that needs to be removed. Controlled hypotension (CH) should be avoided in patients with advanced cardiac disease, history of cerebrovascular abnormalities, and those with chronic kidney and liver disease. 32. A wire-reinforced flexible ETT or RAE ETT may be recommended to facilitate surgical access and are usually taped midline; FLMA is secured in a similar manner. Healthcare providers may also recommend surgery if you have nasal polyps. The indication for surgery may be purely cosmetic, post trauma, reconstructive after tumor resection or to improve nasal breathing. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4702057/). Vaccines & Boosters | Testing | Visitor Guidelines | Coronavirus. This type of surgery does not include cutting the skin because it is performed entirely through the nostrils. A multicenter comparison of maintenance and recovery with sevoflurane or isoflurane for adult ambulatory, 65. No: Many surgeries that require general anesthesia are done with lma (laryngeal mask airway); but the use if lma is contraindicated in many instances. It is common for patients to be on a variety of oral anticoagulants prior to elective FESS, and plans for cessation of anticoagulants and antiplatelet agents for high risk patients should be formulated in consultation with patients cardiologist or primary care physician15,16. If FLMA is chosen, meticulous attention must be directed to the confirmation tests for its placement, to assure adequate ventilation and airway protection58. They typically remove any damaged tissue or bone as part of the surgery. Use of (2)-adrenergic agonists to improve surgical field visibility in endoscopy sinus surgery: a systematic review of randomised controlled trials. Your doctor will provide you with instructions for relieving discomfort and keeping your sinuses clear after FESS, which could include the following: You may experience the following symptoms after endoscopic sinus surgery: You will need to return to your doctor several times after the surgery for follow-ups to aid the healing process. Other people may need a few weeks or months before their symptoms go away. Extubation is the process of having the endotracheal tube removed. Your provider may prescribe pain medication to help with the mild or moderate pain you may have for a week or so after your surgery. Int Forum Allergy Rhinol 2019. Effect of fentanyl nasal packing treatment on patients with acute postoperative pain after nasal operation: a randomized double-blind controlled trial. Arch Surg 2004;139:6772. Moderate, 81. 105. Anesthesiology 2000;93:13459. Healthcare providers use endoscopes to see inside of your nose and sinuses and guide the surgery. Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. 42. There is some discomfort involved with the cleaning, so it is best to take a pain medication 45 minutes before your visit. Comparison of laryngeal mask with endotracheal tube for. A total of 1564 articles were identified and 1454 were analyzed after removing 200 duplicate papers. Wawrzyniak K, Burduk PK, Cywinski JB, et al. Rhinology 2017;55:27480. Proper anesthetic management, however, can indirectly decrease blood loss during FESS by improving the operating conditions and allowing for a more rapid surgery94. Routine and comprehensive preoperative airway evaluation should include a careful history and an 11-point ASA bedside airway examination32. BMC Anesthesiol 2018;18:162. The strategies to achieve these objectives are discussed below. A steadfast maintenance of intraoperative normothermia is also important for the elderly29. Intubation has a risk of dental damage. Heres an overview of the process: This is an alternative to FESS. Intraoperative access to the patients airway is highly restricted, as the OR table is usually turned 90 or 180 degrees away from the anesthesiologist. Kolodzie K, Apfel CC. Wormald PJ, van Renen G, Perks J, et al. Ask your healthcare provider to explain what kinds of complications you may have and what theyll do to help you if you do have complications from sinus surgery. Advertising on our site helps support our mission. In highly motivated patients, selected FESS cases can be performed under local anesthesia with sedation (monitored anesthesia care, MAC). The influence of selected preoperative factors on the course of endoscopic surgery in patients with chronic rhinosinusitis. Bergese SD, Patrick Bender S, McSweeney TD, et al. Get useful, helpful and relevant health + wellness information. Hu C, Yu H, Ye M, et al. Jacob SM, Chandy TT, Cherian VT. Clonidine or, 99. When the septum is crooked, it's known as a deviated septum. Outpatient FESS can be considered a low-risk surgical procedure, with similar rate of major complications (cerebrospinal fluid leak, meningitis, hemorrhage, orbital injuries) recorded for both primary and revision cases (0.36% vs. 0.46%, odds ratio=1.26; 95% confidence interval: 0.792.00)8. Oral O2 administration makes capnography monitoring unreliable, and placement of the precordial stethoscope over the patients trachea to monitor breath sounds may be recommended. Quijada-Manuitt MA, Escamilla Y, Vallano A, et al. These are small bony structures inside of your nose. Stevens WW, Peters AT, Hirsch AG, et al. Jacobi KE, Bohm BE, Rickauer AJ, et al. Achieving effective surgical hemostasis is critical for FESS, as even a small amount of bleeding can have a significant impact on intraoperative exposure. Editorial Comment Wu AW, Walgama ES, Gen E, et al. Decongestant nasal spray with oxymetazoline should be used after surgery if you have steady bleeding that doesnt stop with a gentle head tilt. Altered mental status/unconsciousness. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. Endoscopic sinus surgery; Functional endoscopic sinus surgery; Anesthesia; General anesthesia; Laryngeal mask airway; Controlled hypotension; Deliberate hypotension; Total intravenous anesthesia; Remifentanil. Your healthcare provider will inject local anesthetic into the tissue lining your nose. PloS One 2013;8:e54807. Anesth Analg 2000;90:699705. Fraire ME, Sanchez-Vallecillo MV, Zernotti ME, et al. Ann Allergy Asthma Immunol 2017;118:2869. This review aims to address possible existing gaps in knowledge and summarizes the best practices for perioperative anesthesia management of adult patients presenting for FESS. Sedation of OSA and morbidly obese patients should either be avoided or performed with extreme caution45,46. One, is the Bailey maneuver134, which involves insertion of the LMA behind the existing ETT at a sufficiently deep plane of anesthesia, removal of the ETT, and administration of the ventilatory support through the LMA until the return of spontaneous ventilation and awakening from anesthesia. In general, sinus surgeries arent serious surgeries with significant complications. In small prospective trials, the use of both oral and IV clonidine effectively improved the surgical field for different anesthetic techniques during FESS, compared favorably with IV remifentanil, but results in undesired carry-over patient sedation95101. Most. This surgery widens the drainage passages between your nose and your sinuses, removing bone or infected tissue so mucus trapped in your sinuses can get out. J Anaesthesiol Clin Pharmacol 2017;33:17280. Nasotracheal intubation (NTI) involves passing an endotracheal tube through the naris, into the nasopharynx, and the trachea, most commonly after induction of general anesthesia in the operating room. Endoscopic sinus surgery is an outpatient procedure performed while the patient is asleep under general anesthesia. Rapid diagnosis and early surgical treatment leads to good outcome. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. Randomized controlled trial comparing the supraglottic airway to use of an endotracheal tube in sinonasal surgery. Simple sinus surgery may only require a small dose such as 4 mg IV dexamethasone; however, more extensive polyposis may require a dose up to 12 mg to further decrease postoperative edema. Lastly, the postoperative period for patients undergoing FESS is discussed with an emphasis on approaches that facilitate prompt hospital discharge with high patient satisfaction. Xu R, Lian Y, Li WX. A Phase IIIb, randomized, double-blind, placebo-controlled, multicenter study evaluating the safety and efficacy of dexmedetomidine for sedation during awake fiberoptic intubation. The patients with either known or presumed OSA should undergo outpatient surgery only if their cardiovascular and pulmonary comorbidities are optimized and will especially benefit from multimodal approach to perioperative analgesia38,41,42. Your surgical team will inform you of any other preparations, which may include: The Johns Hopkins Sinus Center provides state-of-the-art evaluation and treatment for a variety of nose and sinus conditions, including environmental allergies, nasal obstruction, nasal tumor and related disorders. Masuki S, Dinenno FA, Joyner MJ, et al. In the past sinus operations were done through incisions . Although this algorithm could be useful in elective Oro-Maxillo-Facial surgery, we would like to highlight the challenges facing nasotracheal intubation during anaesthesia for patients with recent maxillo-facial injuries. Qiao H, Chen J, Li W, et al. Once the tube is removed, the person is able to breathe on their own. If a deviated septum causes breathing problems, specialized instruments can straighten the septum and reduce the size of the turbinates (bony structures inside the sinuses).
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