Perioperative care of patients undergoing Functional Endoscopic Sinus Surgery

The final success and outcomes of patients treatment undergoing Functional Endoscopic Sinus Surgery depends on the correct preparation for surgery, perioperative and postoperative care. Proceedings before FESS in case of chronic rhinosinusitis arise from „European position paper on rhinosinusitis and nasal polyps 2012” and includes pretreatment with local nasal and systemic steroids, sinus irrigation, as well as in some cases antibiotic therapy. Reduction of intra- and post-operative bleeding is possible by intraoperative use of gauze local vasoconstricting inserts, reverse Trendelenburg position, reduction of blood pressure and application of tranexamic acid. After the surgery the use of nasal packing is often recommended. Moreover postoperative care has been largely transferred to the patient and therefore we are highlighting how important is education of patient, providing accurate information and training in the appropriate use of prescribed preparations for na-posal irrigation and nasal steroids. The use of steroids was proved to reduce the risk of recurrence of the disease and it is reasonable when we are sure that they have an opportunity to reach physically to whole mucous membrane of the nose. The effectiveness of nasal irrigation can be enhanced by use of the containers enabling the appropriate application (the exact adherence to the nasal vestibule , at an angle 45° ) and generating sufficient pressure ( rinse of the entire nasal cavity –120 mbar) and the use of appropriate fluid composition accelerates healing and reduce pain. Use of in vitro studies and computational fluid dynamics simulations allow to predict the effectiveness of rinsing different paranasal sinuses.