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Other people may need a few weeks or months before their symptoms go away. Opioid prescription patterns and use among patients undergoing, 164. The trapped fluid can grow bacteria that can cause infections. 48. For practical purposes, the patients with severe OSA should not routinely undergo outpatient FESS surgery under general anesthesia or sedation4. The safety and efficacy of the use of the flexible. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Effective administration of supplemental oxygen (O2) during FESS is problematic, and blunting fluctuating levels of noxious stimulation may be difficult due to the highly variable patients responses. There are, however, a couple of potential risks associated: 1 Acute bacterial sinusitis, infection of the sinuses by bacteria Excessive bleeding in the affected area Why do I prefer not intubating patients? Furthermore, the intraoperative use of IV fentanyl can either be completely avoided, or safely limited to a total dose 12mcg/kg for the majority of patients. The IV placement on the patients side next to the surgeon (usually, on patients right), and the noninvasive blood pressure cuff on the opposite side may be recommended for FESS cases to avoid iatrogenic noninvasive blood pressureinduced tremor interference with precision surgery3. 133. Effect of premedication with systemic steroids on surgical field bleeding and visibility during nasosinusal endoscopic surgery. If MAC is chosen, the desired level of sedation should be clearly defined and discussed with the surgeon preoperatively. These are small bony structures inside of your nose. Nearly 50% of patients with CRS and nasal polyposis develop comorbid asthma, which is thought to impact disease severity and deteriorate intraoperative conditions19,20. Effects of three different types of anaesthesia on perioperative bleeding control in, 71. Experimental pain and opioid analgesia in volunteers at high risk for obstructive sleep apnea. Using the endoscope, they gently enter your nose. Theyll review your medical history, your current sinus situation and your medical history before making a recommendation. Acta Otorhinolaryngol Ital 2004;24:13744. The main goals of sinus surgery are to relieve your symptoms and cut down on how many . The anesthesiologist should act as a knowledgeable consultant for appropriate patient selection and preparation, understand some of the unique anesthetic goals for FESS (Table 1) and be comfortable with total intravenous anesthesia (TIVA).3,4 Most of the FESS procedures are performed in a free-standing ambulatory surgical centers, which presents additional challenges due to a combination of limited anesthesia back-up, variability of monitoring modalities and anesthesia equipment, and the pressure to produce cost-effective, efficient, and quality care.