Anaesthesia in endoscopic sinus surgery

The aim of this study was to evaluate the methods of anaesthesia used in 1,460 patients (677 females and 783 males), aged 4 to 79 years, who were consecutively operated on with a functional endonasal endoscopic approach (FESS) or by an endoscopic endonasal approach (ESS) by one surgeon (AD) in the period from 1987-2001. The included patients presented a variety of disorders within the nose and sinuses. Many of the patients had sinonasal polypoid disease, which had gradually expanded over years and was causing pressure to neighbouring structures. Several had undergone previous multiple surgical procedures altering the original anatomy. However, the majority of the patients had been treated surgically for acute recurrent and/or chronic infections, others for sinogenic headache, benign tumours/mucoceles and smell disorders. The intention of looking into the anaesthetic procedures being used was to clarify the needs for a differentiated anaesthetic approach to different surgical tasks. It is of crucial importance for an optimal surgical result that both the patient and surgeon feel absolutely comfortable during the operation. Local anaesthesia can be used in minor surgery on selected patients and is definitely suitable even for residents in training. General anaesthesia is preferred in most cases by both patients and surgeons. The conclusion of this paper is that total intravenous anaesthesia (TIVA) in addition to oxygen-enriched air through a laryngeal mask airway (LMA) should be the anaesthetic procedure of choice, at least in our experience.