Optimizing the Surgical Field in Pediatric Functional Endoscopic Sinus Surgery: A New Evidence‐Based Approach

Abstract

Improving the quality of the surgical field and providing a bloodless FESS in children is attainable with TIVA. TIVA using a combination of remifentanil and propofol is superior to BA, even with the use of additional potent hypotensive agents such as esmolol. Both techniques are safe and effective in inducing controlled hypotension in children at a target mean arterial blood pressure of 50 mm Hg.

Safety and efficacy of concentrated topical epinephrine use in endoscopic endonasal surgery

“…Previous studies within the literature that largely reported on partial FESS have noted surgical times ranging from 71 to 165 minutes, most of which exceed our reported times even for a complete bilateral procedure. 3,15,[22][23][24][25] Previously reported EBLs during FESS have ranged from 120 to 369 mL, which is greater compared to the blood loss of 61.7 ± 51.6 mL encountered in our patients during a complete FESS. 15,[22][23][24][25][26][27][28] Although this study design cannot control for surgeon experience on these outcome measures, the vasoconstrictive effects of epinephrine are at least a significant, if not the primary, contributor.…”

Target‑controlled infusion of propofol and remifentanil combined with dexmedetomidine reduces functional endoscopic sinus surgery bleeding

“…Although inhalation anesthetics can reduce MAP, the surgical approach was still not improved because of the increased HR and dilated nasal mucosal vessels during FESS (24). Even if balanced anesthesia combined with esmolol controls the HR, the surgical approach is not ameliorated compared with total intravenous anesthesia (25).…”

Controlled Hypotensive Anesthesia in Children Undergoing Nasal Surgery

“…In young children placed in the supine position, a systolic pressure of 55 or 60 mm Hg can be safely used to induce a dry surgical field [4].…”

“…Functional endoscopic sinus surgery was done safely in children using hypotensive anesthesia without any adverse events although the blood pressure was reduced up to 25% below baseline [4].…”