Perioperative management and surgical field optimization in functional endoscopic sinus surgery

Area of Science:

• Anesthesiology
• Otolaryngology
• Surgical Outcomes

Background:

• Functional endoscopic sinus surgery (FESS) requires optimal surgical field visibility for successful outcomes.
• Anesthetic management plays a potential role in minimizing blood loss and enhancing visualization during FESS.

Approach:

• A narrative review of evidence-based practices from 2011-2021 was conducted.
• Literature search focused on perioperative care, anesthetic agents (intravenous vs. inhalation), and operative approaches impacting blood loss and surgical field visibility (VSF).

Key Points:

• Best practices include preoperative steroids, topical vasoconstrictors, patient positioning, controlled hypotension, and specific ventilation settings.
• While some studies favored total intravenous anesthesia (TIVA) over inhalation anesthesia (IA) for VSF, adjunct medications (e.g., remifentanil) appeared more critical than the anesthetic technique itself.
• Current literature presents inconclusive evidence on the direct impact of anesthetic choice on VSF during FESS.

Conclusions:

• Anesthesiologists should prioritize anesthetic techniques they are most comfortable with to ensure efficiency, recovery, cost-effectiveness, and team collaboration.
• Future research should standardize VSF measurement, consider disease severity, and investigate long-term effects of anesthetic-induced hypotension in FESS.