Anesthesia for functional endoscopic sinus surgery.

Area of Science:

• Anesthesiology
• Otolaryngology
• Surgical Innovation

Background:

• Functional endoscopic sinus surgery (FESS) requires optimal surgical conditions, including reduced bleeding and clear visualization.
• Anesthetic management plays a critical role in achieving these conditions.

Purpose of the Study:

• To review anesthetic techniques for FESS aimed at minimizing bleeding and enhancing the surgical field.
• To discuss the physiological basis of these techniques, focusing on their impact on bleeding and surgical field quality.

Main Methods:

• Review of existing literature on anesthetic strategies for FESS.
• Discussion of deliberate hypotension, reverse Trendelenburg positioning, regional anesthesia, and cerebral monitoring.
• Comparative analysis of inhalation anesthesia versus total intravenous anesthesia.

Main Results:

• Literature review shows mixed results regarding inhalation vs. total intravenous anesthesia for surgical field quality and blood loss.
• A trend favors total intravenous anesthesia (TIVA) in current literature.
• Cerebral oximetry and transcranial Doppler ultrasound are emerging methods for monitoring cerebral perfusion during induced hypotension.

Conclusions:

• Total intravenous anesthesia (TIVA) with propofol and remifentanil is the preferred method for deliberate hypotension in FESS.
• This technique provides hemodynamic stability and facilitates rapid patient emergence.
• TIVA contributes to improved surgical outcomes in endoscopic sinus surgery.