Anesthetic considerations for functional endoscopic sinus surgery: a narrative review

Saxena, Amit; Nekhendzy, Vladimir

doi:10.1097/hn9.0000000000000025

Cited by 13 publications

(5 citation statements)

References 156 publications

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“…Effective hemostasis is crucial during FESS since even minor bleeding can severely compromise an already restricted view in the narrow nasal space, prolong the operation, and increase the risk of damage to sensitive tissue structures. The lowering of MAP during general anesthesia can minimize intraoperative bleeding, reduce the time of operation, and improve the quality of surgery ( 3 , 10 ). A prospective, observational cohort study showed that MAP below 60 mmHg was associated with better surgical visibility in terms of bleeding assessment score ( 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…After the surgery, the surgical field was evaluated by the surgeon using Fromme score, which is as follows: 1-slight bleeding without the requirement for blood suctioning, 2-slight bleeding requiring occasional suctioning but surgical field not compromised, 3-slight bleeding requiring frequent suctioning and surgical field affected within a few seconds of removing suction, 4-moderate bleeding requiring frequent suctioning and surgical field directly compromised by bleeding after suction is removed, and 5-severe bleeding that overwhelmed constant suctioning and severely compromised the surgical field and prevented surgery (9).…”

Section: Experimental Protocolsmentioning

confidence: 99%

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Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

Zhang

Xue

et al. 2021

Front. Surg.

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Background: Deliberate hypotension can reduce bleeding and improve visualization of the surgical field during functional endoscopic sinus surgery (FESS). However, hypotension may cause brain hypoperfusion and subsequent ischemic injuries, such as delayed awakening, stroke, postoperative delirium, and postoperative cognitive dysfunction. Near-infrared spectroscopy (NIRS) can be used to monitor real-time regional cerebral oxygen saturation (rSO2) levels to estimate brain perfusion. The present study aimed to evaluate the change in rSO2 induced by deliberate hypotension during FESS, and assess the impact of deliberate hypotension on the surgical process.Material and Methods: A randomized controlled trial was registered with the Chinese clinical trial registry (ChiCTR2000039846). A total of 40 patients were enrolled and randomly divided into the control and intervention groups, and finally, 39 patients were analyzed. Deliberate hypotension was induced in the intervention group using nicardipine and esmolol, whereas the control group received general anesthesia without deliberate hypotension. We recorded mean arterial pressure (MAP), saturation of pulse oximetry (SpO2), rSO2, and heart rate (HR) before induction of anesthesia (T0), immediately after induction of anesthesia (T1), at the beginning of the operation (corresponding with the establishment of deliberate hypotension) (T2), 10 min (T3) and 20 min (T4) after the operation began, at the end of the operation (corresponding with the end of deliberate hypotension) (T5), and 5 min (T6) and 15 min (T7) after the operation. The partial pressure of end-tidal carbon dioxide (PetCO2) was recorded at T1, T2, T3, T4, T5, and T6. The duration of surgery, intraoperative blood loss, tracheal extubation time, and the number of patients that experienced cerebral desaturation events (CDEs) were recorded. The surgical field was estimated postoperation based on the Fromme score.Results: A 30% decrease from the baseline MAP resulted in a decrease of intraoperative bleeding, improvement in the quality of the surgical field, and the shortening of the duration of surgery during FESS in the intervention group compared with the control group. In addition, rSO2 was reduced and no CDEs were experienced in the intervention group. Linear regression analysis demonstrated a correlation between the decline in rSO2 and that in MAP.Conclusions: A decrease in MAP to a certain level will cause a decrease of rSO2 in patients undergoing FESS under general anesthesia. Based on our findings, we recommend that the deliberate hypotensive target indicated by MAP be reduced by 30%, while PetCO2 is maintained at 35–40 mmHg and HR is maintained at about 60 beats per minute during FESS.

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Section: Discussionmentioning

confidence: 99%

Section: Experimental Protocolsmentioning

confidence: 99%

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

Zhang

Xue

et al. 2021

Front. Surg.

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“…ESS aims to create a clear surgical field during the procedure by minimizing bleeding and avoiding injuries to the vascular, cerebrospinal fluid, and orbital tissues [1,[6][7][8]. To achieve this, various techniques are used to reduce blood flow to the intraoperative field.…”

Section: Role Of Anesthesia In the Intraoperative Fieldmentioning

confidence: 99%

“…It is essential for ESS to achieve optimal intraoperative surgical field visibility and minimize blood loss, which is one of the critical factors for successful outcomes. Factors that can influence bleeding during ESS include the use of antiplatelet and/or anticoagulant drugs, hypertension, the Lund-Mackay CT score, damage to vessels due to the altered anatomy, lack of surgeon experience, extensive sinus disease, revision surgery, and poor visualization [1][2][3][4][5]. Intraoperative bleeding during ESS can be challenging due to the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments, which may affect hemostasis [3].…”

Section: Introductionmentioning

confidence: 99%

Effect of Anesthesia on Endoscopic Sinus Surgery Hemostasis: a State-of-the-Art Review

Machado¹

2023

Cureus

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Endoscopic sinus surgery (ESS) is the gold standard for the management of chronic rhinosinusitis, nasal polyposis, and other pathology involving paranasal sinus as tumors. Intraoperative bleeding during ESS can be challenging due to the narrow sinonasal surgical field, single working hand, and the use of endoscopic instruments, which may affect hemostasis. There is a role for the type of anesthesia technique used for intraoperative bleeding control. Total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are some of the techniques available for anesthetic purposes. While both techniques have their advantages and disadvantages, there is a need to compare their efficacy and safety to determine which technique is more appropriate for ESS. In this review, our main focus was to summarize the current evidence about the different techniques of anesthesia used during ESS. A systematic review of the PubMed/MEDLINE database was performed using specific English terms related to TIVA and IA/volatile anesthesia used during ESS. A total of 548 publications were considered. Among these, 329 studies did not fulfill the criteria for inclusion in the systematic review, resulting in the inclusion of only 132 publications: 13 systematic reviews, 32 reviews, 92 randomized controlled trials, and 13 meta-analyses. The state of the art favors the use of TIVA during ESS due to its significant improvement in the intraoperative surgical field with less blood loss. Further studies aim to compare long-term nasal status with objective tools, ideally in similar pathology with the same surgeon.

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“…The essential anesthesia requirements for FESS include airway management, considerations for facilitating surgical access, provision of a clear and still surgical field for precision surgery, assuring quick and non-stimulating emergence from anesthesia, and fast-tracking patients for discharge [2].…”

Section: Introductionmentioning

confidence: 99%

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

Elaziz¹,

Shaban²,

Elaziz³

2020

OJAnes

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Background: After functional endoscopic nasal surgery, emergence agitation is not uncommon. The aim of this trial was to investigate the effect of perioperative lidocaine infusion on postoperative early recovery quality and incidence of emergence agitation in patient undergoing functional endoscopic sinus surgery. Study Design: Prospective, randomized, double-blinded, placebo-controlled trial. Methods: 100 patients of ASA I and II, aged 18 -50 years, of both sexes scheduled for FEES, were assigned into two groups. In Group L; patients received an intravenous bolus infusion of 1.5 mg/kg lidocaine just before induction of anesthesia followed by a continuous infusion of 2 mg/kg/h during the operation and until the end of the surgery. In Group C; patients received normal saline infusion with the same volume as group L according to the same protocol. The primary endpoints were incidence of emergence agitation and postoperative recovery quality (QoR-40) score on first postoperative day (POD1). Results: Incidence of emergence agitation was significantly lower in group L (P < 0.05) compared with group C. Global QoR-40 scores on POD1 were significantly lower in both groups compared with preoperative assessment, it was significantly higher in group L on POD1 (P < 0.05) than in group C. Among the five dimensions of QoR-40, the scores for physical comfort and pain were superior in group L compared to group C (P < 0.05) at POD1. Conclusion: Systemic lidocaine infusion can improve QoR-40 scores and decrease incidence of emergence agitation in patients scheduled for FEES, also it reduces the duration of stay in PACU after surgery.

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Anesthetic considerations for functional endoscopic sinus surgery: a narrative review

Cited by 13 publications

References 156 publications

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

Effect of Deliberate Hypotension on Regional Cerebral Oxygen Saturation During Functional Endoscopic Sinus Surgery: A Randomized Controlled Trial

Effect of Anesthesia on Endoscopic Sinus Surgery Hemostasis: a State-of-the-Art Review

Effects of Lidocaine Infusion on Quality of Recovery and Agitation after Functional Endoscopic Sinus Surgery: Randomized Controlled Study

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