Functional Endoscopic Sinus Surgery (FESS)

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 90 degrees
Time: 1-2 hours (average)
Blood Loss: Low (10-50 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Yes

Induction – ETT/ oral RAE is best. Consider using an LTA kit to prevent coughing. Have a NG tube ready (the surgeon will usually place it for you).

Reduce secretions – Robinul 0.2mg after induction will help to reduce secretions.

Avoid hypertension – Remember to keep BP under control. Avoid hypertension as the nasal airways are very vascular. Persistent bleeding due to hypertension can lead to blood and/or clots in the airway.

Head of Bed (HOB) – HOB May be turned 90 degrees (surgeons preference). HOB is usually up 20-30 degrees for surgery. Keep HOB elevated after emergence.

Clear secretions – Make sure to suction the airway liberally before extubation with a soft catheter.

Throat pack – this will be placed at after induction by the surgeon – make sure it is retrieved after surgery!

Avoid coughing – It is advisable to use an LTA kit on induction/intubation. On emergence, deep extubation is recommended if not contraindicated. On emergence it’s also sensible to use lidocaine IV 0.25mg/kg and/or low doses of fentanyl and propofol for a smooth wake up.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

FESS procedures are typically reserved for patients suffering from chronic nasal conditions who have trouble breathing.

Endoscopic sinus surgery- Surgeon uses a rigid lighted scope to examine a patient’s nasal cavity.

After examination the surgeon can perform a number of sinus surgeries (polypectomy, septal surgeries, turbinoplasty, ethmoid procedure, or washout of a sinus cavity).