This article discusses the importance of anesthesia in endoscopic sinus surgery. Major aim of anesthetist in FESS should be to reduce blood pressure to such a level that bleeding is minimized. It also discusses the various steps that should be followed by surgeons to reduced intra operative bleeding during the procedure.
Bleeding is one complication that could increase the risk of complication during endoscopic sinus surgery.
Considerable amount of attention should be paid to reduce bleeding on the table during the surgical
procedure. Dry surgical field not only improves visibility during endoscopic sinus surgery, it also shortens the
duration of surgery. In this regard both anesthesiologist and the operating surgeon have a vital role to play.
Endoscope becomes rather useless when the operating field bleeds. Bleeding is more common if surgery is
performed on allergic / inflamed nasal mucosa. This is where operating surgeon should take extra precaution
in preparing the patient. Reduction of nasal allergy and inflammation is also known as mucosal preparation
prior to surgery. This is done by administering a course of antibiotic, antihistamine and topical steroid spray 1.
Ideally patient should be prescribed these medications at least 1 week prior to surgery.
According to European rhinological society guidelines chronic rhinosinusitis with nasal polypi and chronic rhinosinusitis without nasal polypi are two different entities. This article attempts to review published literature which attempts to study link between nasal polyposis and lower airway disorders. The concept of unified airway attempts precisely to explain this linkage. Developmentally and functionally it makes sense to combine both upper and lower airways in studying pathophysiology of various airway disorders.
An attempt to define the following terminologies will not be out of place.
Rhinosinusitis / Nasal polyposis:
Number of authors have attempted to define this condition, majority of these definitions were based on symptomatology and duration of the disease. Till date there is no universally accepted definition of this condition 1. European rhinological society has stepped in to define rhinosinusitis in unambiguous terms.
The concept of unified airway disorders has infact shifted the focus from individually managing various disorders affecting the components of airway to that of unified management modality. This calls for multidisciplinary approach in managing these patients in an optimal manner. Specialities involved in designing management protocol for unified airway disorders include Thoracic medicine and otolaryngologists.