International forum of allergy & rhinology
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Int Forum Allergy Rhinol · Jun 2013
ReviewQuality of surgical field during endoscopic sinus surgery: a systematic literature review of the effect of total intravenous compared to inhalational anesthesia.
Adequate surgical field visualization is imperative for successful outcomes in endoscopic sinus surgery (ESS). The type of anesthetic administered can alter a patient's hemodynamics and impact endoscopic visualization during surgery. We review the current evidence regarding the effect of total intravenous anesthesia (TIVA) compared to inhalational anesthesia (INA) on visualization of the surgical field during ESS. ⋯ Although several studies reported that TIVA improves surgical conditions in ESS, there are significant limitations. These findings prevent any definite recommendation at this point, emphasizing the need for further high-quality studies.
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Int Forum Allergy Rhinol · Jun 2013
Review Meta AnalysisMeta-analysis and literature review of techniques to achieve hemostasis in endoscopic sinus surgery.
Functional endoscopic sinus surgery (FESS) has been used as the standard of treatment for sinonasal disease in which medical therapy fails to ameliorate the disease. Intraoperative hemostasis is a crucial factor in FESS. Currently, ideal techniques for creating intraoperative hemostasis have yet to be clarified and standardized. We sought to better understand what variables can affect intraoperative blood loss and therefore improve surgical field outcomes. ⋯ Meta-analysis of 1148 patients concludes that hemostasis during FESS is best conducted using TIVA, preoperative steroids, and topical local anesthetic at a 1:200,000 concentration.
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Advances in endoscopic sinus surgery have led to a greater number of in-office procedures away from the traditional operating room setting. Rhinologists acting independently of anesthesiologists must be prepared for potential complications, such as vasovagal response (VVR), that may arise during in-office rhinologic manipulations. In this study, we review our experience with this condition and discuss risk factors and a management algorithm for in-office VVR. ⋯ Although the incidence of VVR during rhinologic procedures is low, rhinologists should be familiar with this condition and be prepared for its management.