ReviewAnaesthesia for endoscopic endonasal surgery
Section snippets
Anaesthesia for endoscopic endonasal surgery
Endoscope based surgeries have become very popular in otorhinology practice. In the late 1980s removal of hypertrophic inflamed mucosa and debris following chronic sinusitis by endoscopy (known as functional endoscopic sinus surgery, FESS) was initiated. Thereafter endoscopic procedures have evolved tremendously and surgical correction for cerebrospinal fluid (CSF) rhinorhea,1 various skull base surgeries,2 resection of malignant and non-malignant tumours in and around the sinuses,3 reduction
Pre-anaesthetic check up and optimisation
It is important to review the medical management of these patients regarding intake of various hormonal preparations, steroids, non-steroidal anti inflammatory drugs (NSAIDS), bronchodilators and antibiotics. Other medications being taken by the patient for associated medical disorders should also be reviewed. Apart from this airway examination is important in such patients who are mouth breathers and/or have a history suggestive of obstructive sleep apnoea (OSA). It is also important to inform
Local anaesthesia and general anaesthesia
Many ENT surgeons advocate the use of loco regional anaesthesia with or without sedation for these procedures.7 Patients discomfort and pain may predict the impending intrusion into dangerous areas by the endoscope and prevent major complications. Endoscopic surgery under local anaesthesia (LA) may allow for a day care surgical procedure for the patient, however, extensive procedures, revision surgeries and uncooperative and paediatric age group patients will warrant use of general anaesthesia
Blood loss
Extent and pathology of the disease, vascularity of the lesion and the amount of blood loss expected should decide about the need for invasive monitoring required and the cannulation of large veins. Being an endoscopic procedure the main surgical requirement is a blood less field. Bleeding in the surgical field can lead to incomplete surgical procedure and increased risk of complications due to non visualisation of important structures. Many methods have been recommended in literature to
Recovery
A smooth recovery from anaesthesia is desirable in all surgical procedures but specially after endonasal endoscopic surgeries. Straining and coughing on the endotracheal tube may lead to increased bleeding from the operative site leading to collection of blood in the oropharynx which may either be aspirated or lead to complications like laryngospasm. Otolaryngological surgeries have an increased risk of development of postoperative laryngospasm. This has been attributed to increased secretions
Pain
Nasal endoscopic surgeries are thought to be associated with minimal or mild pain only. However Sommer et al. in a recent study to define the prevalence and predictors of postoperative pain in patients undergoing ENT surgery found that unacceptable high levels of pain were present in patients undergoing nasal endoscopic surgery.35 Almost 30% of these patients had a visual analogue score (VAS) of more than 40 mm on a scale of 0–100 at rest and nearly 40% had VAS more than 40 mm on coughing. Thus
Complications
The risk of serious complications after endoscopic sinus surgery has been reported to be less than 1% in the literature.37 The incidence and type of complication will also depend on the type of surgery being undertaken (Table 1). In general the complications include haemorrhage, intracranial, and ocular complications. Haemorrhage can commonly occur from the branches of sphenopalatine artery and less commonly from the anterior cerebral and internal carotid artery. Simple nasal packing is most of
Functional endoscopic sinus surgery
The term was coined by Kennedy et al. in the year 1985 in their classic paper on the theory behind the procedure.39 The procedure is based on the concept that minor pathological changes in the vicinity of the ostiomeatal complex may interfere with mucociliary clearance or with the ventilation of sinuses leading to inflammation and infection and the sinus mucosa will return to normal if adequate drainage can be re-established by removing the mucosal disease in this region.
The procedure is
Conflict of interest
None.
References (44)
- et al.
Propofol vs isoflurane for endoscopic sinus surgery
Am J Otolaryngol
(1999) - et al.
Comparison of surgical conditions during propofol or sevoflurane anaesthesia for endoscopic sinus surgery
Br J Anaesth
(2008) - et al.
clonidine: does it work as a hypotensive agent with inhalation anaesthesia?
Br J Anaesth
(1999 Apr) - et al.
Magnesium sulphate as a technique of hypotensive anaesthesia
Br J Anaesth
(2006) - et al.
Comparison of the reinforced laryngeal mask airway and tracheal intubation for adenotonsillectomy
Br J Anaesth
(1993) - et al.
Repeated attacks of venous air embolism during endoscopic sinus tumour surgery: a case report
Int J Pediatr Otorhinolaryngol
(2005) - et al.
Effect of pharyngeal packing during nasal surgery on postoperative nausea and vomiting
Otolaryngol Head Neck Surg
(2010) - et al.
Pharyngeal packing is a predisposing factor for postoperative aphthous stomatitis in nasal surgery
Otolaryngol Head Neck Surg
(2010 May) Bronchial asthma, nasal polyps, and aspirin sensitivity: Samter’s syndrome
Clin Chest Med
(1988 Dec)- et al.
Anaesthesia in aspirin-induced asthma
Allergol Immunopathol (Madr)
(2003 Nov–Dec)
Transnasal endoscopic repair of cerebrospinal fluid rhinorrhea and skull base defect: ten-year experience
Laryngoscope
What are the limits of endoscopic sinus surgery?: the expanded endonasal approach to the skull base
Keio J Med
Endoscopic sinus surgery for benign and malignant nasal and sinus neoplasm
Curr Opin Otolaryngol Head Neck Surg
Endoscopic endonasal management of medial orbital blowout fractures
Facial Plast Surg
External versus endoscopic dacryocystorhinostomy for acquired nasolacrimal duct obstruction in a tertiary referral center
Ophthalmology
Impact of perioperative systemic steroids on surgical outcomes in patients with chronic rhinosinusitis with polyposis: evaluation with the novel perioperative sinus endoscopy (POSE) scoring system
Laryngoscope
Anaesthesia in endoscopic sinus surgery
Eur Arch Otorhinolaryngol
Factors affecting unanticipated hospital admission following otolaryngologic day surgery
J Otolaryngol
Intravenous anesthesia provides optimal surgical conditions during microscopic and endoscopic sinus surgery
Laryngoscope
Comparison of propofol and sevoflurane anesthesia by means of blood loss during endoscopic sinus surgery
Saudi Med J
Total intravenous anaesthesia in endoscopic sinus-nasal surgery
Acta Otorhinolaryngol Ital
The effect of the total intravenous anesthesia compared with inhalational anesthesia on the surgical field during endoscopic sinus surgery
Am J Rhinol
Cited by (4)
Anaesthesia for ENT surgery - Is there a change?
2011, Trends in Anaesthesia and Critical CareIdeal anaesthesia in nasal surgery
2020, Challenges in RhinologyComparing the effect of oral clonidine and tranexamic acid on bleeding and surgical field quality during functional endoscopic sinus surgery
2018, Iranian Journal of OtorhinolaryngologyQuality of surgical field during endoscopic sinus surgery: A systematic literature review of the effect of total intravenous compared to inhalational anesthesia
2013, International Forum of Allergy and Rhinology