your express consent. The results of the sphenopalatine ganglion block investigations are largely equivocal, with some studies demonstrating lower pain scores, reduced analgesic consumption, less nausea and vomiting, and faster recovery room discharge times151153,155157, and others150 failing to show significant beneficial effects. Prediction of difficult mask ventilation. 136. 2 These include: the infundibular pattern, with inflammation of the maxillary sinus and opacification of the ipsilateral ostium and infundibulum; the ostiomeatal unit pattern, with inflammation of the ipsilateral maxillary, As a result, while the intensity of arterial bleeding during FESS will be mainly influenced by MAP and HR8082, other factors, such as local mechanisms regulating functional capillary networks and venous pressure may play a significant role in regulating overall nasal capillary perfusion94. Search for Similar Articles COVID-19 Updates . Nasogastric tubes pose very few risks when used correctly, but there is the possibility of side effects. Operative times, postanesthesia recovery times, and complications during sinonasal surgery using. But everyones experience is different. Tassler A, Kaye R. Preoperative assessment of risk factors. Anesthesiology 2000;92:122936. 1. Effect of infraorbital nerve block under, 154. Wu AW, Walgama ES, Gen E, et al. DeMaria S, Govindaraj S, Huang A, et al. The essential anesthesia requirements for FESS include airway management considerations for facilitating surgical access, provision of a clear and still surgical field for precision surgery, assuring quick and nonstimulating emergence from anesthesia, and fast-tracking patients for discharge (Table 1). Tel. Effect of premedication with systemic steroids on surgical field bleeding and visibility during nasosinusal endoscopic surgery. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid. Endoscopic sinus surgery is an outpatient procedure performed while the patient is asleep under general anesthesia. Menigaux C, Guignard B, Adam F, et al. Administering a successful MAC without immediate access to the patients airway (the OR table is usually turned away from the anesthesiologist) is frequently more challenging than conducting a general anesthetic4. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3546409/), (https://www.ncbi.nlm.nih.gov/books/NBK563202/#_NBK563202_pubdet_). Making these corrections may also improve your facial appearance. Studies have shown that scheduled oral acetaminophen can provide effective pain control and reduced opioid requirements in the days after surgery146, and the initial investigations into the value of perioperative IV acetaminophen use for pain control after FESS seem encouraging although no definitive conclusions can be made147. 62. Your healthcare provider puts decongestant medication in your nose. For more information, please refer to our Privacy Policy. Proper anesthetic management, however, can indirectly decrease blood loss during FESS by improving the operating conditions and allowing for a more rapid surgery94. Efficacy of esmolol versus alfentanil as a supplement to propofol-nitrous oxide. This technique requires practice but when performed appropriately can be well tolerated by the patient to avoid bucking while still providing adequate oxygenation and ventilation. Endoscopic sinus surgery is a procedure used to remove blockages in the sinuses that cause pain, drainage, infections, impaired breathing or loss of smell. Intraoperative access to the patients airway is highly restricted, as the OR table is usually turned 90 or 180 degrees away from the anesthesiologist. Boezaart AP, Van der Merwe J, Coetzee A. Nasotracheal intubation permits the administration of anesthetic gases without limiting access to intraoral anatomy, and it is commonly used for dental, oropharyngeal, and maxillofacial . Fedok FG, Ferraro RE, Kingsley CP, et al. Minimizing the rise in blood pressure could be accomplished by administering additional anti-hypertensive agents besides -blockade at the time of local anesthetic injection or by decreasing the concentration of epinephrine in the local anesthetic mixture if possible4,14,15. Ellsworth WA, Basu CB, Iverson RE. In a retrospective study of 136 FESS patients, Raikundalia et al164 identified concurrent septoplasty and younger patients age as the factors predisposing to increased postoperative opioid usage. Tramr M, Moore A, McQuay H. Propofol anaesthesia and postoperative nausea and vomiting: quantitative systematic review of randomized controlled studies. A deviated septum can make it harder to breathe through your nose and can increase the risk of sinus infections due to poor drainage. Provision of a clear and still surgical field and assuring smooth, nonstimulating emergence of anesthesia should constitute some of the top priorities for the anesthesiologist. Studies show between 80 % and 90% of people who have FESS for chronic sinusitis feel the surgery cured their problem. Heres an overview of the process: Everyones situation is different, but most functional endoscopic surgeries last about two hours. Any surgery has potential complications, but sinus surgery complications are rare. The physical and emotional well-being of the patient, not to mention a safe field for the surgeon to work, can be positively or negatively influenced by the anesthetic. Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. The effect of intraoperative use of esmolol and nicardipine on recovery after ambulatory surgery. Intubation is usually performed in a hospital during an emergency or before surgery. After locating the problem, the surgeon uses specialized instruments alongside the endoscope to open the sinuses by carefully removing causes of sinus blockage, such as mucous membrane swelling, nasal polyps and scar tissue. Kheterpal S, Healy D, Aziz MF, et al. The aim of our review is to look at the increasing body of literature highlighting the various . This review aims to address possible existing gaps in knowledge and summarizes the best practices for perioperative anesthesia management of adult patients presenting for FESS. Flexible laryngeal mask as an alternative to reinforced tracheal tube for upper chest, head and neck oncoplastic surgery. Fortunately, not all breathing tubes require intubation. 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. Sometimes hospital patients just need additional nutrition to support their healing. He or she guides it through your nasal and sinus passages. Cleveland Clinic is a non-profit academic medical center. Studies show between 80 % and 90% of people whove had this surgery feel it solved their sinus issues. 28. The possibility of difficult mask ventilation and difficult tracheal intubation shall always be considered in OSA patients 33-35. Suzuki S, Yasunaga H, Matsui H, et al. Intubation: What is it, types, procedure, side effects, and pictures Nasotracheal Intubation - StatPearls - NCBI Bookshelf Fever higher than 101 degrees Fahrenheit in the days following surgery, Constant clear watery discharge from the nose a week after surgery, Steady, brisk, nose bleeding that doesnt get better after using decongestant spray. 34. I like to avoid intubation when safely possible! Sedative, amnestic, and analgesic properties of small-dose dexmedetomidine infusions. Highlight selected keywords in the article text. ORIF Surgery: Open Reduction Internal Fixation for Broken Bones Every persons situation is different, but most healthcare providers recommend the following: Healthcare providers do functional endoscopic sinus surgery and balloon sinuplasty by inserting surgical tools into your nose. Multimodal PONV prophylaxis (eg, the addition of transdermal scopolamine patch) is warranted in high risk patients148,149. You have a fever. Comparison of surgical conditions following premedication with oral clonidine versus oral diazepam for, 98. Chung F, Elsaid H. Screening for obstructive sleep apnea before surgery: why is it important? The additional advantage of IV esmolol may be related to its ability to potentiate opioid-induced analgesia, decrease the incidence of postoperative nausea and vomiting, and improve the overall patients recovery room profile118120,122131. 143. 123. Laryngoscope 2010;120:6358. The use of esmolol as an alternative to, 129. Suzuki et al9 found an overall incidence of surgical complications after FESS at 0.5%, with the corresponding rates for cerebrospinal fluid leak 0.09%, orbital injury 0.09%, and hemorrhage requiring surgery 0.1%. Chang CH, Lee JW, Choi JR, et al. Advertising on our site helps support our mission. Sinus surgery may involve removing infected sinus tissue, bone or polyps. It will also minimize the risk of excessive coughing on emergence from anesthesia and in the immediate postoperative period, which may provoke postoperative bleeding. You have pain that your pain medications cant ease. Healthcare providers use this surgery to treat chronic sinusitis, remove nasal polyps and treat other conditions that affect your sinuses. Shen PH, Weitzel EK, Lai JT, et al. They may also use a small rotating burr to scrape out tissue. Intraoperative magnesium sulphate decreases agitation and pain in patients undergoing functional endoscopic surgery: a randomised double-blind study. Get useful, helpful and relevant health + wellness information. Anesthesiology 2006;105:88591. Learn how we can help 4.4k views Answered >2 years ago Thank Functional Endoscopic Sinus Surgery (FESS) - Cleveland Clinic Patients with significant cardiac disease need to be evaluated by the cardiologist preoperatively. Pilot study comparing, 94. If FLMA is chosen, meticulous attention must be directed to the confirmation tests for its placement, to assure adequate ventilation and airway protection58. 130. You should see your healthcare provider for follow-up visits a few weeks after your surgery so they can clean your nose and check on your progress. Elsersy HE, Metyas MC, Elfeky HA, et al. Coloma M, Chiu JW, White PF, et al. Fleisher LA, Pasternak LR, Herbert R, et al. Depression symptoms and lost productivity in chronic rhinosinusitis. 158. Last reviewed by a Cleveland Clinic medical professional on 04/04/2022. Gray ML, Fan CJ, Kappauf C, et al. J Appl Physiol 2005;99:58792. Svider PF, Nguyen B, Yuhan B, et al. Bhat Pai RV, Badiger S, Sachidananda R, et al. Prevention of this complication begins with recognition of a potentially difficult intubation and applying good practice rules. Minor bleeding, pain, congestion, discharge and fatigue are common after the surgery, but should go away in one to three weeks. Your FESS may not solve your sinus condition because its a chronic condition, but FESS can significantly ease your symptoms and limit how often your chronic sinus flares. Besides medications, the influence of intraoperative factors, such as carbon dioxide (CO2) level and mechanical ventilation modalities on intraoperative bleeding and quality of surgical field has been investigated in a number of ESS trials94,132,133. PDF Functional endoscopic sinus surgery (FESS) - wsh.nhs.uk Sevoflurane in combination with, 145. The conventional interventions, such as elevating the patients head 1520 degrees67,68 (reverse Trendelenburg position should be avoided to prevent intraoperative fluid shifts), topical decongestion of the nasal mucosa, and the use of injectable vasoconstrictors by the surgeon play an important role in optimizing the view of the operative field. Extubation is the process of having the endotracheal tube removed. What are the risks of intubation for surgery and anesthesia? Oda Y, Nishikawa K, Hase I, et al. Thirty years of endoscopic sinus surgery: What have we learned? Efficacy of intraoperative dexmedetomidine infusion on visualization of the surgical field in, 115. Surgery may be an option if your sinusitis is due to a deviated septum, polyps, or other structural problems. Chaaban MR, Baroody FM, Gottlieb O, et al. Dexmedetomidine as sole sedative for awake intubation in management of the critical airway. The insertion procedure is brief lasting only a few minutes. Bergese SD, Patrick Bender S, McSweeney TD, et al. 131. Propofol vs. inhalational agents to maintain general anaesthesia in ambulatory and in-patient surgery: a systematic review and meta-analysis. The immediate recovery room period after FESS is usually uncomplicated. But you can stay intubated (with a breathing tube in place) for days or weeks depending on your medical needs. Upon review, 260 references were identified as pertinent and 164 articles were selected for this publication. 30. The properly placed FLMA creates a reliable oropharyngeal seal, adequately protecting the lower airway from blood, secretions, irrigation fluid and surgical debris48,5557. J Allergy Clin Immunol Pract 2017;5:106170. Furthermore, with the use of FLMA neuromuscular blockade can be avoided and the resumption of adequate spontaneous ventilation is greatly facilitated58. Using the endoscope, they gently enter your nose. Stevens WW, Peters AT, Hirsch AG, et al. Our providers specialize in head and neck surgery and oncology; facial plastic and reconstructive surgery; comprehensive otolaryngology; laryngology; otology, neurotology and lateral skull base disorders; pediatric otolaryngology; rhinology, sinus and skull base surgery; surgical sleep; dentistry and oral and maxillofacial surgery; and allied hearing, speech and balance services. Desflurane versus sevoflurane for maintenance of outpatient, 67. J Am Coll Cardiol 2014;64:e77137. Depending on your daughter's age and which procedure is performed, she may or may not require intubation. Efficacy of tranexamic acid on operative bleeding in, 70. Several small prospective randomized trials attempted to further improve postoperative analgesia and patients recovery profile through the use of the regional nerve blocks, most commonly sphenopalatine ganglion block150157. In some studies, no clear direct correlation between intraoperative MAP and blood loss could be demonstrated78,79,8992. Bairy L, Vanderstichelen M, Jamart J, et al. Application of deliberate hypotension for orthognathic surgeries decreases blood loss. Dexmedetomidine has been extensively studied due to its dose-dependent sedation and anxiolysis, potentiation of the opioid analgesia, absent or minimal respiratory depression, and additional antisialagogue, antitussive and sympatholytic properties102110. 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. Ankichetty SP, Ponniah M, Cherian V, et al. Apfel CC, Philip BK, Cakmakkaya OS, et al. Why Do Some Patients Need To Be Intubated? Saxena, Amit MD; Nekhendzy, Vladimir MD, FASA, Departments of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Stanford, CA. Functional endoscopic sinus surgery (FESS) is minimally invasive surgery for serious sinus conditions. 147. If the patients baseline functional capacity is moderate-to-excellent then additional cardiac testing should not be required. Perioperative use of inhaled bronchodilators is indicated in these patients16, and intraoperative use of NSAIDs including IV ketorolac, should be avoided21. The role of endoscopic sphenopalatine ganglion block on nausea and vomiting after sinus surgery. The adult patients presenting for FESS are diverse and could be either completely healthy (American Society of Anesthesiologists [ASA] physical status I) or have controlled systemic diseases of varying severity (ASA physical status IIIII). Recommendations at a glance. Many nasal procedures can successfully be performed under local anesthesia with sedation. Prediction and outcomes of impossible mask ventilation: a review of 50,000 anesthetics. Intravenous, 82. This review article discusses state-of-the-art perioperative anesthesia care for patients presenting for functional endoscopic sinus surgery (FESS). There are several types of sinus surgeries designed to be less invasive with shorter recovery times. Septoplasty - Mayo Clinic Endoscopic sinus surgery is the name given to operations used for severe or difficult to treat sinus problems. Medicine (Baltimore) 2019;98:e17254. Clinical characteristics of patients with chronic rhinosinusitis with nasal polyps, asthma, and aspirin-exacerbated respiratory disease. The clinical significance of these findings may apply mostly to cases where larger than usual intraoperative bleeding is anticipated. 120. Functional endoscopic sinus surgery (FESS) is standard surgery for chronic sinus problems that keep you from breathing with ease. 57. Your healthcare provider makes an incision in your gum between your upper lip and gum tissue to get to the wall of your maxillary sinus. You wont be able to drive after surgery, so youll need someone to take you home and stay with you that first night. Anesthesiology 2000;93:13459. Range of S-100 levels during, 78. Soppitt AJ, Glass PS, Howell S, et al. Preoperative administration of systemic antibiotics or steroids to counteract active infection and decrease tissue swelling will vary depending on surgeons preference22. Webster AC, Morley-Forster PK, Janzen V, et al. Drummond GB. This may go on for a few weeks while your sinuses heal. Theyll slowly inflate the balloon to unblock your sinuses. Youll spend some time in a recovery room so your healthcare provider can monitor your condition. 126. Complications are rare and may include: At Another Johns Hopkins Member Hospital: Sinus Surgery for Nasal Polyps: Nici's Story. 12. 6. Obese patients have a higher incidence of adverse airway events on induction and emergence from anesthesia37. Int Forum Allergy Rhinol 2018;8:87782. Created for people with ongoing healthcare needs but benefits everyone. Jaw surgery, also known as orthognathic (or-thog-NATH-ik) surgery, corrects irregularities of the jaw bones and realigns the jaws and teeth to improve the way they work. The effect of deliberate hypercapnia and hypocapnia on intraoperative blood loss and quality of surgical field during, 95. 36. 31. Jaw surgery may be a corrective option if you have jaw problems that can't be resolved with orthodontics alone . (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw]) AND English [lang] AND (Preoperative Care[mesh] OR preoperative assessment [tw] OR preoperat* [ti] OR (anesth* [ti] AND (evaluat* [ti] AND assess* [ti]))), (Nerve Block [mesh] OR nerve block [tw] OR , ((Anesthetics, Inhalation [mesh] AND Anesthetics, Intravenous [mesh]) OR (inhal* [ti] AND intravenous [ti]) OR (TIVA [ti] AND inhal* [ti])) AND ((paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw])) AND English [lang], (hypotension [ti] OR blood Pressure [mesh] OR , (Pain Management [mesh] OR pain measurement [mesh] OR Pain, Postoperative [mesh] OR pain [mesh] OR pain [ti]) AND (paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw]) AND English [lang], (inpatient [ti] OR outpatient [ti] OR inpatients [mesh] OR outpatients [mesh] OR patient admission [mesh] OR admission [ti] OR admitted [ti]) AND ((paranasal sinuses/surgery [mesh] OR sinusitis/surgery [mesh] OR (sinus* [tw] AND surg* [ti])) AND (Endoscopy [mesh] OR endoscop* [tw])) AND English [lang], Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0/, www.anesthesiologynews.com/download/3Maneuvers_ANGAM10_WM.pdf, Anesthetic considerations for functional endoscopic sinus surgery: a narrative review, Articles in Google Scholar by Amit Saxena, MD, Other articles in this journal by Amit Saxena, MD, Privacy Policy (Updated December 15, 2022). Most patients do not require nasal packing that needs to be removed. Nasal saline irrigation flushes out the nasal and sinus cavities to manage polyps. Your healthcare provider may recommend FESS if you have chronic sinus inflammation or a chronic sinus infection that doesnt improve with medical treatments, such as antibiotics and medications to manage allergies. Bergese SD, Candiotti KA, Bokesch PM, et al. Some conditions that may require temporary tube feeding through a nasogastric tube include: Difficulty swallowing ; Head and neck cancers. Your healthcare provider will tell you what to expect after surgery. Intubation is a standard procedure that involves passing a tube into a person's airway. Predictors of unanticipated admission within 30 days of outpatient sinonasal surgery. Your message has been successfully sent to your colleague. Intranasal atomised dexmedetomidine optimises surgical field visualization with decreased blood loss during, 113. Blood loss during, 91. It is common for patients to be on a variety of oral anticoagulants prior to elective FESS, and plans for cessation of anticoagulants and antiplatelet agents for high risk patients should be formulated in consultation with patients cardiologist or primary care physician15,16. NOSE AND THROAT SURGERIES SUCH AS TONSILLECTOMY AND RHINOPLASTY: Almost all nose and throat surgeries require an airway tube, so anesthetic gases and oxygen can be ventilated in and out through your windpipe safely during the time the surgeon is working on these breathing passages. Last reviewed by a Cleveland Clinic medical professional on 06/29/2022. Higashizawa T, Koga Y. to maintaining your privacy and will not share your personal information without They inject a numbing solution into your nose. Ebert TJ, Hall JE, Barney JA, et al. Ann Allergy Asthma Immunol 2017;118:2869. Smoking can make your sinus symptoms worse. Shukry M, Miller JA. The short-acting beta1-adrenoceptor antagonists esmolol and landiolol suppress the bispectral index response to tracheal intubation during sevoflurane. The effect of the, 83. Intubation: Purpose, Procedure and Potential Risks - Cleveland Clinic 150. The enhanced sensitivity of OSA patients to opioids and benzodiazepines39,40 may lead to rapidly developing respiratory depression and airway obstruction. 29. Wormald PJ, van Renen G, Perks J, et al. Sajedi P, Rahimian A, Khalili G. Comparative evaluation between two methods of induced hypotension with infusion of, 132. 20. The sinuses are a group of spaces formed by the bones of your face. Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during, 68. Ask your healthcare provider to explain what kinds of complications you may have and what theyll do to help you if you do have complications from sinus surgery. Philip BK, Kallar SK, Bogetz MS, et al. Schechtman SA, Wertz AP, Shanks A, et al. Anesthesia for Sinus Surgery. Functional endoscopic sinus surgery is also called endoscopic sinus surgery. Jacobi KE, Bohm BE, Rickauer AJ, et al. Anaesthesia 1991;46:3667. 13. Minimally invasive sinus surgery such as FESS and balloon sinuplasty often cures sinus issues. Bettelli G. High risk patients in day surgery. Data is temporarily unavailable. Preparation. Post intubation esophageal perforation is one of the most life-threatening iatrogenic esophageal perforation. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, Functional Endoscopic Sinus Surgery (FESS). Endoscopic sinus surgery; Functional endoscopic sinus surgery; Anesthesia; General anesthesia; Laryngeal mask airway; Controlled hypotension; Deliberate hypotension; Total intravenous anesthesia; Remifentanil. A study to compare the quality of surgical field using, 77. The indication for surgery may be purely cosmetic, post trauma, reconstructive after tumor resection or to improve nasal breathing. Tests they may use include: Your healthcare provider will let you know what to do before your surgery. Fleisher LA, Fleischmann KE, Auerbach AD, et al. While infiltrative submucosal local anesthesia is used commonly by the surgeon intraoperatively, adequate analgesia may be difficult to attain secondary to preexisting mucosal inflammation, extensive polyposis, bleeding and other technical difficulties158. Blackwell KE, Ross DA, Kapur P, et al. Evaluation of the patients cardiac status should follow the American College of Cardiology (ACC) and American Heart Association (AHA) guidelines on perioperative evaluation and care for noncardiac surgery13. National survey on the use of preoperative systemic steroids in, 27. Standard IV induction with propofol and opioid is used most often, and propofols beneficial antiemetic effect is facilitated if TIVA is used for maintenance59,60. Comparison of metoprolol and tramadol with. This may be a sign of infection. Incidence and predictors of difficult and impossible mask ventilation. Complications may include: Persistent sinus pain and stuffiness arent life-threatening medical conditions but they can affect your quality of life. Images of the area can be seen through the endoscope. During the surgery: After surgery, you will spend a few hours in a recovery room to allow you to wake up. Langeron O, Masso E, Huraux C, et al. Healthcare providers use general or local anesthesia when they do sinus surgery. If you have chronic sinusitis and medical treatment hasnt helped, ask your healthcare provider if FESS is an option. No: Many surgeries that require general anesthesia are done with lma (laryngeal mask airway); but the use if lma is contraindicated in many instances. General anesthesia means youre unconscious and dont feel any pain. Yu SK, Tait G, Karkouti K, et al. 59. Wolters Kluwer Health, Inc. and/or its subsidiaries. 44. J Anaesthesiol Clin Pharmacol 2017;33:17280. Surgical conditions during FESS; comparison of dexmedetomidine and, 116. Oral O2 administration makes capnography monitoring unreliable, and placement of the precordial stethoscope over the patients trachea to monitor breath sounds may be recommended. Choi EM, Park WK, Choi SH, et al. How Nasal Polyps Are Removed: Medication, Surgery, and More - Healthline Hu C, Yu H, Ye M, et al. Endoscopic sinus surgery is usually performed as an outpatient procedure with the patient under general anesthesia (asleep). Please try again soon. 37. Outpatient FESS can be considered a low-risk surgical procedure, with similar rate of major complications (cerebrospinal fluid leak, meningitis, hemorrhage, orbital injuries) recorded for both primary and revision cases (0.36% vs. 0.46%, odds ratio=1.26; 95% confidence interval: 0.792.00)8. It can be used to assist with breathing during surgery or to support breathing in people with lung disease, chest trauma, or airway obstruction. Early BP control is essential for preventing occult postoperative bleeding, and is usually achieved by administration of IV labetalol, 0.10.2mg/kg, in repeated doses. Compared with MAC, general anesthesia provides adequate amnesia, protects patients airway, assures adequate gas exchange, and abolishes patients movement4. 146. Nasotracheal intubation (NTI) involves passing an endotracheal tube through the naris, into the nasopharynx, and the trachea, most commonly after induction of general anesthesia in the operating room. 14. Most people recover from sinus surgery within a few days. True deep extubation has associated risks after FESS because of the increased risk of postextubation laryngospasm and increased need for airway support on the part of the anesthesiologist4,21. 161. For the most part, FESS has relatively few complications. Esophageal perforation: life threatening complication of endotracheal

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